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Outflow resistance measurement during infrainguinal arterial reconstructions: a reliable predictor of limb salvage
Insights
Intraoperative outflow resistance measurements accurately predict limb salvage after infrainguinal bypass surgery. This helps surgeons decide between bypass and amputation for critical limb ischemia.
Area of Science:
- Vascular Surgery
- Surgical Outcomes Research
Background:
- Critical limb ischemia necessitates infrainguinal arterial reconstructions.
- Predicting limb salvage is crucial for deciding between bypass surgery and amputation.
Purpose of the Study:
- To evaluate intraoperative outflow resistance measurements as predictors of limb salvage after infrainguinal bypass.
- To assess the efficacy of these measurements in guiding surgical decisions.
Main Methods:
- Reviewed 134 infrainguinal bypass operations (femoropopliteal and femorodistal) for critical ischemia.
- Measured and quartiled intraoperative outflow resistance.
- Analyzed 1-year limb salvage and graft patency rates based on resistance quartiles.
Main Results:
- For femorodistal bypasses, limb salvage rates significantly decreased with increasing outflow resistance (p < 0.05).
- Higher outflow resistance in femorodistal bypasses correlated with lower limb salvage and graft patency.
- Intraoperative outflow resistance proved to be an accurate predictor of limb salvage.
Conclusions:
- Intraoperative outflow resistance measurement is a reliable predictor of limb salvage after infrainguinal bypass.
- This measurement aids in optimizing surgical strategy for critical limb ischemia.
- It helps determine the likelihood of successful limb salvage versus major amputation.
Abstract:
Criteria for abandoning infrainguinal arterial reconstructions in favor of major amputations should include reliable predictors not only of graft patency, but more importantly, of limb salvage. To evaluate the efficacy of intraoperative outflow resistance measurements in predicting limb salvage after infrainguinal bypasses, we have reviewed 134 such operations (64 femoropopliteal and 70 femorodistal bypasses) performed for critical ischemia. Outflow resistance measurements were divided into quartiles for femoropopliteal bypasses (Group A 0.17 mm Hg/ml/min or less, Group B 0.18 to 0.24 mm Hg/ml/min, Group C 0.25 to 0.4 mm Hg/ml/min, and Group D greater than 0.4 mm Hg/ml/min) and femorodistal bypasses (Group A 0.4 mm Hg/ml/min or less, Group B 0.4 to 0.58 mm Hg/ml/min or less, Group C 0.6 to 1 mm Hg/ml/min, and Group D 1 mm Hg/ml/min or greater). One year limb salvage rates for patients who underwent femoropopliteal bypass were 95 percent, 92 percent, 87 percent, and 67 percent from the lowest to the highest quartile (difference not statistically significant), and for those who had femorodistal bypass, they were 51 percent, 75 percent, 48 percent, and 0, respectively (p less than 0.05). Interestingly, 12 month graft patency and limb salvage rates for patients who underwent femorodistal bypass with outflow resistances between 0.59 and 1 mm Hg/ml/min did not correlate well (22 percent and 48 percent, respectively), whereas for those with outflow resistance greater than 1 mm Hg/ml/min, they were 22 percent and 22 percent, respectively. Thus, measurement of intraoperative outflow resistance is a very accurate predictor of limb salvage after infrainguinal bypass operations.