Infrageniculate vein bypass graft for critical limb ischaemia: one surgeon's experience
E M Macaulay1, A K Samy, G G Cooper
1Department of Vascular Surgery, Aberdeen Royal Infirmary, UK.
Insights
Vein bypass surgery for critical limb ischemia shows significantly lower graft patency in femorocrural procedures compared to femoropopliteal bypasses. Femorocrural bypasses also resulted in higher amputation rates.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Peripheral Artery Disease
Background:
- Critical limb ischemia (CLI) poses a significant risk of amputation and mortality.
- Autogenous vein bypass grafting is a common revascularization strategy for CLI.
- Outcomes may differ based on the target arterial segment (femoropopliteal vs. femorocrural).
Purpose of the Study:
- To compare the outcomes of vein bypass grafting to the femoropopliteal segment versus the femorocrural arteries in patients with CLI.
- To evaluate graft patency, limb salvage, and mortality rates between the two surgical approaches.
Main Methods:
- Retrospective analysis of 63 patients undergoing vein bypass for CLI by a single surgeon.
- Comparison of 31 infrageniculate femoropopliteal bypasses with 32 femorocrural bypasses.
- All patients enrolled in a graft surveillance program.
Main Results:
- At 3 years, femoropopliteal bypasses demonstrated significantly higher secondary patency rates (93%) compared to femorocrural bypasses (64%) (P < 0.01).
- Primary patency at 3 years was 86% for femoropopliteal and 55% for femorocrural bypasses.
- Major amputation occurred in 5 patients, all within the femorocrural group. Mortality rates were 31% (femoropopliteal) and 53% (femorocrural) at 3 years.
Conclusions:
- Femoropopliteal vein bypasses yield superior long-term patency and limb salvage rates compared to femorocrural bypasses for critical limb ischemia.
- Graft surveillance is crucial for monitoring bypass performance.
- The higher failure and amputation rates in femorocrural bypasses warrant careful consideration in surgical planning for CLI.
Abstract:
The results of 63 patients under the care of one surgeon who underwent a bypass, using vein, for critical limb ischaemia are presented. Thirty-two operations were to the crural vessels and the results are compared with those for 31 infrageniculate femoropopliteal bypasses. All patients were entered into a graft surveillance programme. There were no graft failures after 1 year in the femoropopliteal group with primary, primary assisted and secondary patency rates of 86, 90 and 93% respectively at 3 years. In the femorocrural group the rates were 55, 60 and 64% respectively. The difference in secondary patency was considered statistically significant (P < 0.01). Mortality rate of the femoropopliteal group was 31% at 3 years compared with 53% for the femorocrural group (n.s.). Five patients underwent major amputation, all of whom were in the femorocrural group. Failures, interventions and the effect of graft surveillance are discussed and the high mortality rate is highlighted.
