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Reconstructive vascular surgery below the knee.

L B Rasmussen, R Jelnes, P Sager

    Annales Chirurgiae Et Gynaecologiae
    |January 1, 1986
    PubMed
    Summary
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    This study on peripheral vascular disease suggests below-knee reconstructive surgery improves outcomes. Despite poor graft patency, distal vascular surgery offers an alternative to amputation for patients with critical limb ischemia.

    Area of Science:

    • Vascular Surgery
    • Peripheral Vascular Disease
    • Limb Ischemia

    Background:

    • Advanced peripheral vascular disease (PVD) significantly impacts patient quality of life, often leading to rest pain and potential amputation.
    • Reconstructive vascular surgery aims to restore blood flow and prevent limb loss in patients with severe PVD.

    Purpose of the Study:

    • To evaluate the effectiveness of below-knee reconstructive vascular surgery in patients with advanced peripheral vascular disease and rest pain.
    • To assess graft patency rates and the impact of surgery on amputation rates.

    Main Methods:

    • A series of 38 consecutive patients with advanced peripheral vascular disease underwent reconstructive vascular surgery with distal anastomosis below the knee.
    • Preoperative and follow-up Ankle/Arm Pressure Index (AAI) measurements were recorded.

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  • Graft patency and amputation rates were monitored over time.

    • Main Results:

    • Preoperative AAI was 0.28, indicating severe ischemia.
    • Accumulated graft patency rates were 47% at one year and 22% at three years.
    • At follow-up, 11 of 34 surviving patients had patent grafts with normalized AAI (0.87).

    Conclusions:

    • Despite a poor prognosis for graft patency, distal vascular surgery should be considered a viable option before proceeding with primary amputation.
    • Reconstructive surgery can help avoid amputation even in cases of graft occlusion.
    • Further research into improving long-term graft patency in below-knee bypass is warranted.