Five year experience with axillopopliteal bypasses for limb salvage

Area of Science:

• Vascular Surgery
• Limb Salvage Procedures
• Reconstructive Surgery

Background:

• Standard bypass procedures often fail or are not feasible for patients with complex lower limb vascular disease.
• Severe atherosclerotic disease, failed previous bypasses, and graft infections necessitate alternative revascularization strategies.
• Limb salvage is crucial to prevent amputation in patients with critical limb ischemia.

Purpose of the Study:

• To evaluate the efficacy of axillopopliteal bypass using 6 mm polytetrafluoroethylene grafts in limb salvage.
• To identify indications and assess outcomes for axillopopliteal bypass in challenging vascular cases.
• To determine graft patency and limb salvage rates in patients ineligible for standard bypass procedures.

Main Methods:

• Retrospective analysis of 34 axillopopliteal bypasses performed over 5 years.
• Utilized 6 mm polytetrafluoroethylene grafts for all procedures.
• Assessed graft patency using objective measures and life table analysis.

Main Results:

• Cumulative graft patency rates were 77% at 1 year, 51% at 3 years, and 45% at 5 years.
• 22 limbs were salvaged with functional revascularization for at least 1 year.
• 9 limbs were salvaged for 2 years or longer, avoiding amputation.

Conclusions:

• Axillopopliteal bypass is a valuable option for limb salvage when standard reconstructions are not feasible due to disease or infection.
• Despite moderate patency rates, the procedure successfully salvages limbs in situations where amputation is the only alternative.
• Continued use of axillopopliteal bypass is justified for high-risk patients facing imminent amputation.