Management of combined segment disease

Area of Science:

• Vascular Surgery
• Surgical Outcomes
• Peripheral Artery Disease

Background:

• Combined segment disease presents a challenge in peripheral artery disease management.
• Revascularization strategies aim to improve limb perfusion and salvage.
• Distinguishing between limb salvage and claudication indications is crucial.

Purpose of the Study:

• To compare the efficacy of aortofemoral bypass versus axillofemoral bypass for combined segment disease.
• To evaluate the utility of a predictive index derived from segmental plethysmography.
• To assess the outcomes of synchronous procedures in selected cases.

Main Methods:

• Retrospective analysis of 148 inflow procedures, with 85 for combined segment disease.
• Comparison of clinical and functional outcomes between aortofemoral and axillofemoral bypass.
• Application of a predictive index derived from segmental plethysmography for patient selection.

Main Results:

• Aortofemoral bypass demonstrated superior clinical and functional results compared to axillofemoral bypass in limbs with combined segment disease requiring salvage.
• Outcomes for both procedures were comparable in patients with claudication.
• The predictive index effectively identified limbs unlikely to respond to aortofemoral bypass alone.
• Synchronous procedures in selected limbs with ischemic lesions and specific predictive index values yielded favorable early results with low morbidity.

Conclusions:

• Aortofemoral bypass is the preferred method for limb salvage in combined segment disease.
• The predictive index is a valuable tool for preoperative patient selection.
• Synchronous procedures offer a viable option for complex cases, improving functional outcomes.