Bifurcated bypass in severe chronic limb threatening ischaemia

Area of Science:

• Vascular Surgery
• Limb Salvage Surgery
• Angiosome Concept

Background:

• Revascularization is key for limb salvage in chronic limb-threatening ischemia (CLTI).
• Endovascular approaches are not always feasible or successful.
• Bifurcated bypasses can restore perfusion to multiple foot arteries when single bypasses are insufficient.

Purpose of the Study:

• To evaluate the safety and effectiveness of bifurcated bypass surgery for CLTI.
• To assess outcomes in patients unsuitable for or failed endovascular treatment.

Main Methods:

• A prospective database analysis of 35 patients undergoing bifurcated bypass for CLTI (Jan 2014-Dec 2019).
• Evaluation of primary and assisted primary bypass patency, amputation-free survival, morbidity, and mortality at 12 and 24 months.
• Data collected included patient demographics, Wound, Ischemia, foot Infection (WIfI) and Rutherford classifications.

Main Results:

• 100% immediate technical success with 5.5% early mortality and 33.3% morbidity.
• At 24 months, primary and assisted primary patency rates were 59.9% and 73.4%, respectively.
• Amputation-free survival was 78.8% at 24 months, with overall survival at 91.6%.

Conclusions:

• Bifurcated bypass is a safe and effective option for CLTI when endovascular treatment is not viable.
• The procedure shows particular promise in diabetic patients.
• Careful patient selection is essential due to the complexity and invasiveness of the surgery.