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Repeat leg bypass after multiple prior bypass failures

R D De Frang1, J M Edwards, G L Moneta

  • 1Division of Vascular Surgery, Oregon Health Sciences University, Portland.

Journal of Vascular Surgery
|February 1, 1994
PubMed
Summary
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Aggressive revascularization for severe lower extremity ischemia after multiple bypass failures offers surprisingly good limb salvage and patency rates. This approach, despite prior failures, demonstrates a low operative mortality and justifies continued surgical intervention.

Area of Science:

  • Vascular Surgery
  • Peripheral Artery Disease
  • Reconstructive Surgery

Background:

  • Optimal treatment for severe lower extremity ischemia with multiple failed bypasses remains unclear.
  • The likelihood of revascularization failure in such complex cases is not well-defined.

Purpose of the Study:

  • To evaluate the outcomes of an aggressive surgical policy for repeated revascularization in patients with severe lower extremity ischemia and prior failed bypasses.
  • To determine the efficacy of limb revascularization in patients with multiple infrainguinal bypass failures.

Main Methods:

  • Retrospective review of 85 revascularization procedures in 81 patients (1980-1992) with at least two prior failed infrainguinal bypasses.
  • Procedures included graft revisions (30%) and replacements (70%), with a focus on autogenous reconstruction (79%).

Related Experiment Videos

  • Distal anastomoses were performed to the popliteal (19 patients) or infrapopliteal arteries (66 patients).

    • Main Results:

    • Mean follow-up was 17 months; 4-year primary patency rate was 79.8%, and limb salvage rate was 69.6%.
    • Operative mortality was 4%. Hypercoagulable disorders, including anticardiolipin antibodies, were identified in 15% of screened patients.
    • Mean time to failure for first and second bypasses was 24 and 4.9 months, respectively.

    Conclusions:

    • Limb revascularization after multiple failed bypasses yields favorable 4-year primary patency and limb salvage rates.
    • An aggressive surgical policy for repeated revascularization in this challenging patient group is justified by the low operative mortality and good long-term outcomes.
    • High patient survival rates support continued intervention for severe lower extremity ischemia despite prior surgical failures.