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Arterial reconstruction for lower limb ischaemia in Hong Kong Chinese
A K Ah Chong1, K M Chiu, S F Lo
1Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong.
Insights
Peripheral arterial disease management in Hong Kong involved 91 arterial bypass operations for severe lower limb ischaemia. The study found a 5-year foot salvage rate of 84% and graft patency of 56%.
Area of Science:
- Vascular Surgery
- Peripheral Arterial Disease
- Public Health
Background:
- Peripheral arterial disease (PAD) and lower limb ischaemia are less common in Chinese populations.
- Arterial bypass operations for PAD are infrequently performed in this demographic.
- This study reports on the management of severe lower limb ischaemia in Hong Kong between 1990 and 1996.
Purpose of the Study:
- To evaluate the outcomes of arterial bypass surgery for severe lower limb ischaemia in a Chinese population.
- To assess the feasibility of adopting Western management strategies for PAD in Hong Kong.
- To analyze the effectiveness of surgical interventions for foot salvage and claudication.
Main Methods:
- A total of 91 primary arterial bypass operations were performed on 83 patients.
- Procedures included 84 foot salvage operations and 7 for debilitating claudication.
- Bypass types comprised infra-inguinal, aorto-iliac, femoro-femoral, aortobifemoral, axillobifemoral, and cross-femoral grafts.
Main Results:
- Six patients (6.6%) died postoperatively, all in the foot salvage group.
- The cumulative 5-year foot salvage rate was 84%.
- The overall 5-year graft patency rate was 56%.
Conclusions:
- The aggressive surgical approach used in Western countries is justified for treating PAD in Hong Kong.
- Peripheral arterial disease appears to be an emerging health concern in the region.
- These findings support the adoption of similar management strategies for PAD in Chinese populations.
Background:
Lower limb ischaemia due to peripheral arterial disease is uncommon in Chinese people, and few arterial bypass operations have been performed. The management of a consecutive series of patients who were admitted to our department with severe lower limb ischaemis between March 1990 and October 1996 is reported here.
Methods:
A total of 91 primary arterial bypass operations were performed for 83 patients (eight patients had bilateral, or two procedures). Of these, 84 operations were for foot salvage and seven operations were for debilitating claudication. There were 80 infra-inguinal bypasses, 10 of which required additional femoro-femoral crossover grafts to improve in-flow. The remaining 11 bypass procedures were performed for aorto-iliac occlusion, which included aortobifemoral bypass (5), axillobifemoral bypass (3) and cross-femoral bypass (3) grafts. There were 46 male and 37 female patients, with a median age of 70 years (36-94).
Results:
Six patients died (6.6%) postoperatively, all of whom were in the foot salvage group. The overall cumulative foot salvage rate and graft patency was 84 and 56%, respectively, at 5 years.
Conclusions:
These results justified the use of the same aggressive approach that was adopted in Western countries for the treatment of peripheral arterial disease, which seemed to be an emerging problem in Hong Kong.