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Updated: Aug 7, 2026
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Extended femoro-distal bypasses for limb salvage: are they worthwhile?
Insights
Distal arteriovenous fistulas improve bypass patency for limb-threatening leg ischemia. This adjunct measure offers favorable limb salvage and graft patency rates, particularly in complex cases with poor arterial run-off.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
Background:
- Limb-threatening leg ischemia presents a significant challenge in vascular surgery.
- Reconstructions for peripheral arterial occlusions often depend on the quality of distal arterial pathways.
Purpose of the Study:
- To evaluate the efficacy of distal arteriovenous fistulas as an adjunct measure in femoro-distal bypasses for limb salvage.
- To assess the impact of adjunct arteriovenous fistulas on graft patency in patients with critical limb ischemia.
Main Methods:
- A retrospective analysis of 93 patients with limb-threatening leg ischemia.
- Surgical procedures included malleolar bypasses, sequential bypasses, and femoro-distal bypasses with adjunct arteriovenous fistulas (n=67).
- Focus on patients with peripheral calf and foot arterial occlusions and poor run-off.
Main Results:
- Adjunct arteriovenous fistulas resulted in 79% graft patency at one month and 77% limb salvage.
- At two years, graft patency was 47% and limb salvage was 52%.
- Favorable outcomes were noted for malleolar and sequential bypasses when distal pathways were adequate.
Conclusions:
- Distal arteriovenous fistulas can be a valuable adjunct for maintaining bypass patency in the crural region for limb salvage.
- This technique is particularly indicated for patients with critical limb ischemia and extremely poor distal run-off.
- The success of bypass reconstructions is significantly influenced by the quality of the primary and secondary foot arcades.
Unlabelled:
In this report on 93 patients with limb-threatening leg ischemia the surgical procedures applied were malleolar bypasses (14), sequential bypasses (12) and femoro-distal bypasses with adjunct AV fistulas (67). The first two methods resulted in favourable limb-salvage and patency rates. However the results of such reconstructions essentially depend on the quality of primary and secondary foot arcades. In peripheral calf and foot arterial occlusions we have applied a distal arteriovenous fistula as an adjunct measure to maintain bypass patency in the crural region. 67 patients were operated on according to this method: 30 females and 37 males with an average age of 70.3 years. 29% had rest-pain and 71% had gangrene. The majority had already been operated on at least once. 7 patients had been amputated contralaterally.
Results:
79% of the patients had a patent graft after one month. The incidence of limb salvage was 77%. At two years 47% of all grafts are still patent and the incidence of limb-salvage is 52%. However, this operation should be exclusively designed for limb-salvage and for cases with extremely poor run-off.
