Popliteal-to-Distal Extreme Bypass in Endovascular Era

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Surgical Outcomes Research

Background:

• Chronic limb-threatening ischemia (CLTI) presents significant mortality (20% annually) and amputation (40%) risks without intervention.
• Open bypass surgery is a recommended treatment for CLTI, contingent on vein quality, outflow artery patency, and surgical skill.
• Popliteal-to-distal bypass is a specific surgical approach evaluated in this study.

Purpose of the Study:

• To evaluate the primary patency, limb salvage, and survival rates following popliteal-to-distal bypass surgery.
• To assess secondary outcomes including amputation-free survival and secondary patency.
• To analyze the feasibility and effectiveness of this bypass technique in CLTI patients.

Main Methods:

• A retrospective analysis of consecutive patients undergoing popliteal-to-distal bypass from January 2016 to December 2021.
• Inclusion criteria focused on patients with CLTI undergoing this specific bypass procedure.
• Primary endpoints included primary patency, limb salvage, and overall survival; secondary endpoints were amputation-free survival and secondary patency.

Main Results:

• Technical success was achieved in 100% of the 49 included patients.
• Two-year primary patency was 85% ± 5%, with secondary patency at 86% ± 3%.
• Two-year overall survival was 81% ± 6%, amputation-free survival was 70% ± 9%, and limb salvage rate was 81% ± 6%.

Conclusions:

• Popliteal-to-distal bypass is a technically demanding procedure requiring significant surgical expertise.
• The study indicates that this bypass can be successfully performed with favorable patency and survival rates when adequate autologous vein and outflow artery are available.
• This surgical option holds promise for limb salvage in select CLTI patients.