The multiple sequential distal bypass graft: seven-year follow-up

Area of Science:

• Vascular Surgery
• Reconstructive Surgery

Background:

• Severe femoropopliteal occlusive disease poses a significant risk of limb loss.
• Infrainguinal bypass grafting is a critical intervention for limb salvage.

Purpose of the Study:

• To evaluate the efficacy and durability of infrainguinal bypass grafts with multiple sequential distal anastomoses for limb salvage.
• To assess graft patency and limb salvage rates in patients with severe peripheral artery disease.

Main Methods:

• Retrospective analysis of 39 infrainguinal bypass grafts in 35 patients with severe femoropopliteal occlusive disease.
• Grafts utilized saphenous vein, polytetrafluoroethylene (PTFE), or composite materials with multiple distal anastomoses.
• Life-table analysis was employed to determine long-term patency and limb salvage rates.

Main Results:

• Early (30-day) graft patency was 93%.
• Long-term primary patency for saphenous vein grafts was 52% at 7 years; secondary patency was 65% at 7 years.
• Cumulative limb salvage rates were 85% at 5 years and 61% at 7 years.
• Mean ankle-arm index improved from 0.38 preoperatively to 0.89 postoperatively.

Conclusions:

• Multiple sequential distal bypass grafting is a durable and highly effective procedure for limb salvage in patients with severe femoropopliteal occlusive disease.
• The technique offers significant improvements in graft patency and limb salvage rates, enhancing patient outcomes.