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Femorotibial bypass: the learning curve
M G Wyatt1, V F Kernick, H Clark
1Department of Surgery, Royal Devon and Exeter Hospital, Wonford.
Annals of the Royal College of Surgeons of England
|November 1, 1995
Summary
Femorotibial bypass surgery outcomes were initially poor in a district hospital due to a learning curve. Improved patient selection and technique now yield comparable results to teaching hospitals, enabling limb salvage.
Area of Science:
- Vascular Surgery
- Peripheral Arterial Disease Management
Background:
- Femorotibial bypass is underutilized in district hospitals due to perceived technical difficulty and high failure rates.
- The learning curve for establishing this procedure can significantly impact early outcomes.
Purpose of the Study:
- To review the initial outcomes of femorotibial bypass surgery performed de novo in a district general hospital.
- To identify factors contributing to early graft failure and limb loss.
- To assess the long-term viability of limb salvage in this setting.
Main Methods:
- Retrospective review of 85 femorotibial bypass grafts performed between 1987 and 1992 in 76 patients.
- Analysis of graft types (autogenous vein, PTFE, composite, umbilical vein) and indications (ulceration/gangrene, rest pain, claudication).
- Evaluation of early graft failure, amputation rates, and patient mortality.
Main Results:
- Overall early graft failure was 26%, with 21 amputations and a 3.9% early mortality rate.
- At follow-up, 39 limbs were amputated and 24 patients had died.
- Twenty-three patients (44% of survivors) had patent grafts, with 3-year primary patency rates comparable to teaching hospitals.
Conclusions:
- Initial disappointing results were attributed to the surgical learning curve and potentially overly inclusive patient selection.
- A more selective approach and refined technique have improved outcomes.
- Femorotibial bypass can achieve worthwhile limb salvage and acceptable patency rates in district general hospitals.