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Extra-anatomic bypass surgery for critical leg ischemia. A review
1III Department of Surgery University La Sapienza, Rome, Italy.
Insights
Extra-anatomic bypass grafts offer a viable solution for critical limb ischemia (CLI) when conventional surgery is not possible. These bypasses can successfully salvage limbs, even if the graft itself later occludes.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
Background:
- Aggressive revascularization for critical limb ischemia (CLI) improves outcomes and is cost-effective compared to amputation.
- Extra-anatomic bypass (EAB) grafts are an alternative when aortofemoral reconstruction is contraindicated due to local conditions or comorbidities.
Purpose of the Study:
- To evaluate the effectiveness of EAB grafts in managing CLI patients unsuitable for conventional repair.
- To assess limb salvage and graft patency rates in the context of EAB for CLI.
Main Methods:
- Literature review of existing data on EAB grafting for CLI.
- Analysis of patient subgroups with multilevel obstructive disease and contraindications for aortofemoral reconstruction.
Main Results:
- EAB grafts demonstrate limb-salvage rates exceeding their patency rates.
- Revascularization can heal ischemic extremities prior to potential graft occlusion.
- Satisfactory outcomes are achievable in selected CLI patients with complex disease patterns.
Conclusions:
- EAB grafting is a valuable option for limb salvage in specific CLI patient populations.
- The procedure offers a successful alternative when standard aortofemoral bypass is not feasible.
Abstract:
Since an aggressive revascularisation policy for critical limb ischemia (CLI) has been shown to lower morbidity and mortality, to improve quality of life and to be cost-effective in comparison to amputation, extra-anatomic bypass (EAB) grafts may be indicated whenever hostile local conditions or severe medical diseases contraindicate an aortofemoral reconstruction. Most series report limb-salvage rates markedly higher than the related patency rates, as revascularisations may often heal the ischemic extremity before the graft occludes. A large review of data from the literature suggests that EAB grafting for CLI may achieve gratifying results in a subgroup of patients with multilevel obstructive disease and not suitable for conventional aortofemoral repair.