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[Reversed vein bypass for the femoro-popliteal axis (author's transl)]
Insights
Saphenous bypass surgery can save limbs and restore function, but careful patient selection is crucial. Early detection of bypass issues like stenosis or aneurysm is vital for better outcomes.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
Context:
- 129 saphenous femoro-popliteal or infra-popliteal bypasses performed in 125 patients.
- Indications included intermittent claudication (55), rest pain (32), and distal gangrene (38).
Purpose:
- To evaluate the long-term outcomes and complications of saphenous bypass surgery.
- To establish guidelines for operative indications and follow-up management.
Summary:
- Follow-up ranging from one to seven years revealed a limb salvage rate, pain relief, and return to work in most cases, despite a 4% mortality and decreased bypass patency over time (88% at 1 year to 58% at 5 years).
- Strict criteria for intermittent claudication are recommended, while limb-threatening ischemia warrants immediate surgical intervention.
- Bypass thrombosis necessitates prompt return to the original surgical team.
- Preventive reoperations for stenosis or aneurysm show better outcomes than curative ones, emphasizing systematic surveillance.
Impact:
- Highlights the limb-saving potential of bypass surgery in critical limb ischemia.
- Underscores the importance of judicious patient selection for intermittent claudication.
- Stresses the need for timely intervention in bypass complications and the benefits of proactive surveillance for stenosis and aneurysms.
Abstract:
One hundred and twenty nine saphenous femoro-popliteal or infra-popliteal bypass were realised in 125 patients, 55 for very short distance intermittent claudication, 32 for rest pain, 38 for distal gangrene. A one to seven years follow up allows to draw four conclusions: -- In spite of a 4% mortality and a decrease of permeability from 88% at one year to 58% at 5 years, one must consider that in most cases the limb was saved, pain disappeared and the patient was able to work again. -- In case of intermittent claudication, operative indication should be very limited to severe socio-professional disturbance. In contrast, one should not hesitate in case of limb threatening. -- If a thrombosis of the bypass occurs, the spontaneous prognosis is hazardous and the patient should immediately be sent back to the surgical team that first operated. -- Since preventive reoperations have better prognosis than curative reoperations, the authors emphazise the interest of a systematic research of late stenosis or aneurism at the bypass level or up or down in order to correct the trouble prior to acute ischemic complication.