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Infrainguinal arterial reconstruction for claudication: is it worth the risk? An analysis of 409 procedures
J Byrne1, R C Darling, B B Chang
1Vascular Institute, Albany Medical Center, NY, USA.
Insights
Infrainguinal arterial reconstruction for disabling claudication is safe and durable in selected patients. This procedure offers good graft patency and survival rates, challenging previous concerns about limb loss and complications.
Area of Science:
- Vascular Surgery
- Peripheral Arterial Disease
- Reconstructive Surgery
Background:
- Infrainguinal reconstruction is typically for limb-threatening ischemia.
- Surgery for debilitating claudication has been historically discouraged due to risks of graft failure, limb loss, and perioperative complications.
Purpose of the Study:
- To evaluate the outcomes of infrainguinal reconstructions for claudication.
- Assess bypass graft patency, limb loss rates, and long-term survival.
Main Methods:
- Retrospective review of vascular registry, office charts, and hospital records.
- Data collected for patients undergoing infrainguinal bypass grafting for claudication between 1987 and 1997.
Main Results:
- 409 infrainguinal reconstructions for claudication were performed (9% of all infrainguinal reconstructions).
- Operative mortality was 0%; one limb lost due to distal embolization.
- Four-year primary patency rates: 62% (above-knee popliteal), 77% (below-knee popliteal), 86% (tibial).
- Cumulative patient survival rates at 4 and 6 years were 93% and 80%, respectively.
Conclusions:
- Infrainguinal arterial reconstruction is a safe and durable option for selected patients with disabling claudication.
- Concerns regarding limb loss, death, and limited lifespan may be unwarranted for these patients.
Purpose:
Infrainguinal reconstruction traditionally has been reserved for patients with limb-threatening ischemia. Surgery for debilitating claudication, however, has been discouraged as a result of the perceived fear of bypass graft failure, limb loss, and significant perioperative complications that may be worse than the natural history of the disease. In this study, the results of infrainguinal reconstructions for claudication performed during the past 10 years were evaluated for bypass graft patency, limb loss, and long-term survival rates.
Methods:
Data were collected and reviewed from the vascular registry, the office charts, and the hospital records for patients who underwent infrainguinal bypass grafting for claudication.
Results:
From 1987 to 1997, 409 infrainguinal reconstructions were performed for claudication (9% of all infrainguinal reconstructions in our unit). The patient population had the following demographics: 73% men, 28% with diabetes, 54% smokers, and an average age of 64 years (range, 24 to 91 years). Inflow was from the following arteries: iliac artery/graft, 10%; common femoral artery, 52%; superficial femoral artery, 19%; profunda femoris artery, 16%; and popliteal artery, 2%. The outflow vessels were the following arteries: 165 above-knee popliteal arteries (40%), 150 below-knee popliteal arteries (37%), and 94 tibial vessels (23%). The operative mortality rate was 0%, and one limb was lost in the series from distal embolization. The primary patency rates were 62%, 77%, and 86% for above-knee popliteal artery, below-knee popliteal artery, and tibial vessel reconstructions at 4 years, and the secondary patency rates were 64%, 81%, and 90%, respectively. Cumulative patient survival rates were 93% and 80% at 4 and 6 years as compared with 65% and 52%, respectively, for infrainguinal reconstructions performed for limb salvage.
Conclusion:
Infrainguinal arterial reconstruction for disabling claudication is a safe and durable procedure in selected patients. These data indicate that concern for limb loss, death, and limited life span of the patients with this disease may not be warranted.