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Long-term results of 44 cross-over bypasses
M H Brouwer1, R G Biemans, H P Donders
1Surgical Department, Stadsmaten Hospital, Enschede, The Netherlands.
Insights
Cross-over bypass surgery effectively treats unilateral iliac obstruction, improving blood flow and limb salvage for patients with critical limb ischemia. This vascular procedure offers a viable option for high-risk individuals experiencing severe leg pain or gangrene.
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.
Abstract:
Forty-four patients with an unilateral iliac obstruction were treated with a cross-over bypass. The ASPI at rest in the recipient leg was 0.53 +/- 0.16 pre-operatively and had increased to 0.82 +/- 0.13 3 months after operation (p less than 0.001). One patient died within 30 days of operation and in another graft thrombosis occurred within this period. In 2 patients above-knee amputation had to be performed owing to graft failure. During the follow-up period (3 months to 10 years) 9 patients died and 8 late graft failures (30 days) occurred without limb loss. The cumulative patency rate amounted to 73.7% after 5 years. A significant steal effect could not be demonstrated. The cross-over bypass is a procedure justified in unilateral iliac occlusion in high- and moderate risk patients with intermittent claudication and pain at rest or gangrene.