Factors determining the outcome of crural and pedal revascularisation for critical limb ischaemia

The influences of clinical factors, site of distal anastomosis, type of graft and angiographic run-off, on graft patency and limb salvage following 141 femorocrural and pedal bypasses in 121 patients were investigated retrospectively. The grafts consisted of 111 femorocrural and 30 pedal bypasses; 49% of the patients had diabetes mellitus. Venous grafts were implanted in 116 limbs, using either in situ vein (65), reversed vein (38) or composite vein (13) graft. Twenty-five prosthetic grafts (14 PTFE and 11 umbilical veins) were inserted. After 1, 2, 3 and 4 years of follow-up, the primary cumulative patency rates for all grafts were respectively 67, 61, 55 and 55%, and the secondary patency rates were 75, 70, 64 and 64%. The site of distal anastomosis had no influence on graft patency rate; neither was there any significant effect of clinical risk factors and run-off on graft patency. Prosthetic grafts showed significantly lower patencies compared to venous grafts and appeared to be the only independent prognostic risk factor for graft failure (multivariate analysis; p = 0.03). Overall limb salvage rate was 84% at 3 years. There were four amputations with patent grafts. The limb salvage rates for in situ vein, reversed/composite vein and prosthetic grafts were 89, 79 and 66% at 3 years, respectively. Various bypass grafts to the crural and pedal arteries are successful and durable. The use of prosthetic grafts results in significantly lower patency rates, but appears to be effective for limb salvage.