Ten year experience with infrainguinal revascularization for limb salvage

Area of Science:

• Vascular Surgery
• Peripheral Artery Disease
• Limb Salvage Surgery

Background:

• Severe, symptomatic infrainguinal ischemia presents a critical challenge, with revascularization being the sole alternative to amputation.
• Assessing the long-term efficacy of revascularization procedures is vital for patient outcomes.

Purpose of the Study:

• To evaluate the success of infrainguinal revascularization, specifically focusing on limb salvage rates.
• To analyze a personal 10-year operative experience with these procedures.

Main Methods:

• Conducted a retrospective analysis of 312 primary infrainguinal bypass procedures on 271 patients (1983-1992).
• Included repeat revascularization for failing or failed grafts, contingent on limb viability and outflow vessel availability.
• Utilized preoperative and intraoperative angiography to assess graft status.

Main Results:

• Achieved a 5-year patient survival rate of 57% and a cumulative 72-month limb salvage rate of 72%.
• Autologous conduits demonstrated superior primary and secondary graft patency (57%/67% at 60 months) compared to nonautologous conduits (20%/21%).
• 19% of extremities required reoperations for graft failure, with 44 amputations resulting from unsuccessful revisions.

Conclusions:

• Infrainguinal revascularization is a viable treatment option with low mortality and high success rates for limb salvage.
• Emphasizes the necessity of long-term postoperative surveillance and reintervention to maintain graft patency and limb salvage.
• Highlights the superior long-term patency of autologous conduits in infrainguinal bypass surgery.