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Benefits of arterial reconstruction in claudication
1Second Department of Surgery, Aichi Medical University, Japan.
Insights
Surgical reconstruction for claudicants shows midterm benefits. Direct and indirect proximal revascularization offer high graft patency and survival rates, while distal revascularization is less effective.
Area of Science:
- Vascular Surgery
- Surgical Reconstruction
- Claudication Treatment
Background:
- Peripheral artery disease (PAD) leading to claudication necessitates effective surgical interventions.
- Midterm outcomes of different arterial reconstruction techniques require evaluation.
Purpose of the Study:
- To assess midterm cumulative patency, survival, and palliation rates after surgical reconstruction in 150 claudicants.
- To compare outcomes between direct (in situ) proximal, indirect (ex situ) proximal, and distal revascularization procedures.
Main Methods:
- Midterm follow-up of 150 patients with claudication undergoing surgical reconstruction.
- Categorization into three groups: direct proximal (n=89), indirect proximal (n=33), and distal (n=28) revascularization.
- Assessment of secondary patency, survival, and palliation rates at 3 years.
Main Results:
- Three-year secondary patency rates: 97.5% (direct proximal), 97.0% (indirect proximal), 75.0% (distal).
- Three-year survival rates: 86.0% (direct proximal), 69.5% (indirect proximal), 95.8% (distal).
- Three-year palliation rates: 84.8% (direct proximal), 70.0% (indirect proximal), 77.9% (distal). Minimal amputation due to graft thrombosis.
Conclusions:
- Supra- and infrainguinal arterial reconstructions demonstrate midterm benefits for claudicants.
- Patient risk assessment, appropriate procedure selection, graft material choice, and postoperative management are crucial for successful outcomes.
Abstract:
We conducted a midterm follow-up of 150 claudicants who underwent surgical reconstruction by assessing cumulative patency, survival, and palliation (graft patency in live patients) rates. Eighty-nine claudicants (group I) underwent direct (in situ) proximal revascularization, 33 (group II) had indirect (ex situ) proximal revascularization, while 28 (group III) had distal revascularization. The secondary patency rates at 3 years were 97.5% in group I, 97.0% in group II, and 75.0% in group III, respectively. Only one patient with limb graft thrombosis required below-knee amputation. There were 3 perioperative deaths (2 in group I and 1 in group II). The survival rates at 3 years were 86.0% in group I, 69.5% in group II, and 95.8% in group III, respectively. The palliation rates at 3 years were 84.8% in group I, 70.0% in group II, and 77.9% in group III, respectively. These findings indicate the midterm benefits of supra- and infrainguinal arterial reconstructions, and also suggest that the preoperative assessment of risks in individual patients, the selection of the appropriate operative procedure and graft material, and intensive postoperative follow-up and management of any associated disease are all important aspects in the treatment of claudicants.