Sequential aortofemoropopliteal/distal bypass for treatment of critical lower-limb ischaemia

Multilevel arterial occlusive disease is often the main cause of critical ischaemia of the lower limb. The aim of this study was to determine the diagnostic criteria that could help select patients for sequential aortofemoropopliteal/distal reconstruction and to compare the results after simultaneous and two-stage surgery. Some 1953 aortofemoral reconstructions were performed during a 6-year period (1987-1992). In 245 cases (12.5%) sequential aortofemorodistal (popliteal or tibia) procedures were performed for critical limb ischaemia Fontaine classification grade III and IV. Two-segment reconstructions were performed in one stage in 161 cases (group A), and two separate operations were performed, the outflow procedure usually following within 12 months after inflow surgery, in 84 cases (group B). The preoperative mortality rates were 3.2% in group A (five deaths) and 5.9% in group B (five deaths). Limb salvage rates were 95.6% at 1 year and 90.4% at 5 years for group A and 88.8% at 1 year and 80.0% at 5 years for group B. Primary inflow bypass patency rates were 97.7% at 1 year and 91.3% at 5 years for group A and 93.4% at 1 year and 76.3% at 5 years for group B, while secondary inflow bypass patency rates were 98.8% at 1 and 5 years for group A, and 95.3% and 88.3% at 1 and five years respectively for group B. Primary outflow bypass patency rates were 91.4% at 1 year and 65.5% at 5 years for group A, and 84.9% at 1 year and 59.4% at 5 years for group B. Secondary outflow bypass patency rates were 92.2% at 1 year and 81.8% at 5 years for group A, and 86.1% at 1 year and 65.9% at 5 years for group B. The data demonstrate that single-stage multisegment reconstruction for multilevel arterial occlusive disease is a safe and effective method of treating critical limb ischaemia.