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Sequential by-passes for limb salvage
J P Favre1, J P Gournier, M Marcy
1Department of Vascular Surgery, CHRU Hôpital Nord, St. Etienne, France.
The Journal of Cardiovascular Surgery
|April 1, 1994
Summary
Sequential bypass grafting effectively treats severe limb ischemia by improving blood flow to the foot, leading to successful healing of trophic lesions and high limb salvage rates.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
- Reconstructive Surgery
Background:
- Direct foot revascularization is crucial for healing distal trophic lesions.
- Bypass grafting on isolated popliteal segments is not always feasible.
- Multi-segmental arterial occlusions necessitate advanced surgical techniques.
Purpose of the Study:
- To evaluate the efficacy of sequential bypass grafting for limb salvage in patients with severe ischemia.
- To assess the patency rates and limb salvage outcomes of this surgical approach.
Main Methods:
- A retrospective analysis of 53 sequential bypass grafts performed between 1988 and 1992 in 52 patients.
- Grafts utilized autogenous saphenous vein, homologous saphenous vein, or composite materials (PTFE+saphenous).
- Anastomoses were performed sequentially on femoral, popliteal, and distal arteries.
Main Results:
- The study achieved 1-year primary and secondary patency rates of 66% and 79%, respectively.
- 2-year patency rates were 51% (primary) and 76% (secondary).
- Limb salvage rates were 89% at 1 year and 86% at 2 years.
Conclusions:
- Sequential bypass grafting is a valuable alternative for limb salvage in severe ischemia.
- This technique offers hemodynamic advantages, particularly for patients with poor distal runoff.
- It represents a viable option when standard bypass procedures are not suitable.