Long-term results of 44 cross-over bypasses

Area of Science:

• Vascular Surgery
• Peripheral Artery Disease

Background:

• Unilateral iliac obstruction significantly impairs lower limb perfusion.
• Patients often present with intermittent claudication, rest pain, or gangrene, indicating critical limb ischemia.
• Surgical revascularization is crucial for limb salvage and improving quality of life.

Purpose of the Study:

• To evaluate the efficacy and safety of cross-over bypass surgery for unilateral iliac obstruction.
• To assess the impact of the procedure on ankle-brachial systolic index (ASPI) and limb salvage.
• To determine the long-term patency rates and identify potential complications.

Main Methods:

• A cohort of 44 patients with unilateral iliac obstruction underwent cross-over bypass surgery.
• Ankle-brachial systolic index (ASPI) was measured pre-operatively and at 3 months post-operatively.
• Patient outcomes, including graft patency, limb salvage, and mortality, were monitored during a follow-up period of 3 months to 10 years.

Main Results:

• ASPI significantly improved from 0.53 +/- 0.16 pre-operatively to 0.82 +/- 0.13 at 3 months (p < 0.001).
• Early complications included one peri-operative death and one graft thrombosis; two above-knee amputations occurred due to graft failure.
• The cumulative graft patency rate was 73.7% at 5 years, with no significant steal effect observed.

Conclusions:

• Cross-over bypass is a justified surgical option for unilateral iliac occlusion in high- and moderate-risk patients.
• The procedure demonstrates significant improvement in limb perfusion and offers limb salvage in patients with critical limb ischemia.
• Long-term patency rates are favorable, supporting its role in managing severe peripheral artery disease.