Distal versus Ultradistal Bypass Grafts: Amputation-free Survival and Patency Rates in Patients with Critical Leg Ischaemia

Slim, Hani; Tiwari, Alok; Ahmed, Ayman; Ritter, Jens Carsten; Zayed, Hany; Rashid, Hisham

doi:10.1016/j.ejvs.2011.03.016

Cited by 40 publications

(27 citation statements)

References 22 publications

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“…Technical details of the bypass procedure have been published previously. Preoperative duplex imaging was used to identify a venous conduit where possible, with the great saphenous vein (GSV) as the preferred conduit, followed by the short saphenous vein (SSV) or arm veins (cephalic and basilic veins).…”

Section: Methodsmentioning

confidence: 99%

Comparison of angioplasty and bypass surgery for critical limb ischaemia in patients with infrapopliteal peripheral artery disease

Patel

Biasi

Paraskevopoulos

et al. 2016

British Journal of Surgery

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Section: Methodsmentioning

confidence: 99%

Comparison of angioplasty and bypass surgery for critical limb ischaemia in patients with infrapopliteal peripheral artery disease

Patel

Biasi

Paraskevopoulos

et al. 2016

British Journal of Surgery

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“…Grafts with diameter less than 3.5 mm and smaller length have 50% probability for patency at least 1 year, if constructed above relatively healthy arterial segment, while a graft with larger diameter and bigger length -36%. Some studies have shown that poor run-off affects negatively the patency of infrainguinal reconstructions [30][31][32]. Patency of infrainguinal bypass and subsequent limb salvation depend crucially on the quality of the distal arterial segment.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Venous Graft Size and Run-Off Segment for Peripheral Bypass Patency

Jordanov¹

2015

J Vasc Med Surg

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Aim: To analyze the one-year-patency of infrainguinal arterial reconstructions in relation to venous graft diameter and length and the run-off segment, when arteries above the proximal anastomosis of the reconstruction are not diseased.Material and Methods: We compared retrospectively for two-year period the diameter, the length of the used vein and the run-off segment in 107 consecutively constructed infrainguinal autovenous bypasses -54 patent (not less than 1 year) and 53 failed bypasses Diameter of the vein was measured at the narrowest part of the vein (in all cases this was the area of the distal anastomosis). Аll bypassеs are made with translocated nonreversed vein and the length of the vein was measured after the completion of reconstruction. Volume and pressure of blood flow were measured below the distal anastomosis by the means of ultrasound transit-time flowmetry. For the assessment of run-off segment Fourier analyses of flow and pressure were used and alteration of the amplitudes after intragraft infusion of Prostaglandines was calculated.Results: We compared the alteration in amplitudes in failed and patent for at least 1 year bypasses and estimated that ratio below 2 before and after medicamentous vasodilatation, sets the reconstruction in the group of threatened, as well as graft diameter below 3.5 mm and length over 40 cm.Conclusion: Hemodynamic assessment of blood flow below distal anastomosis defines the necessary vein lenght, that is why run-off segment has the most important significance for the patency of the infrainguinal autovenous reconstructions. Shorter grafts with diameter over 3.5 mm do not guarantee longer patency if distal anastomosis is constructed above diseased run-off segment.

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“…Angioplasty and bypass are regarded not as competing but as complementary treatments. Also, a recent study has shown that both distal and ultra‐distal bypass have comparable outcomes regardless of the comorbidities . After either angioplasty or bypass, patients are followed up closely in the Diabetic Foot Clinic to assess the clinical outcome and the need for further intervention.…”

Section: The Multidisciplinary Diabetic Foot Teammentioning

confidence: 99%

The benefits of working together in diabetic foot care for the vulnerable patient

Edmonds

2016

Pract Diab

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The patient with a diabetic foot is extremely complex and vulnerable to tissue necrosis because three great pathologies come together in the diabetic foot: neuropathy, ischaemia and infection. As a result of neuropathy, the signs and symptoms of external physical insults and of infection may be minimal. Nevertheless, the pathology emanating from such insults and infection proceeds rapidly without the body being aware of them and the end‐stage of tissue death is quickly reached. Thus, the window of opportunity for intervention is limited and is often missed. From a practical point of view, the diabetic foot can be divided into two main entities: the neuropathic foot and the ischaemic foot. The neuropathic foot is vulnerable to attack from mechanical forces leading to ulceration and also to bacteriological invasion resulting in tissue necrosis. The diabetic ischaemic foot commonly presents as the neuroischaemic foot which is characterised by both ischaemia and neuropathy leading to ulcers commonly seen on the margins of the foot and toes. These ulcers are also prone to bacteriological invasion, again resulting in tissue necrosis. However, it has been shown that such a vulnerability of the diabetic foot patient to tissue necrosis can be successfully managed by the development of a multidisciplinary diabetic foot team which provides prompt outpatient care in a diabetic foot clinic and inpatient care on the hospital wards. Such a development has promoted advances in clinical care, research and education, has stimulated the creation of the subspecialty of diabetic foot care, and has shown that most major amputations can be avoided. Copyright © 2016 John Wiley & Sons.

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Distal versus Ultradistal Bypass Grafts: Amputation-free Survival and Patency Rates in Patients with Critical Leg Ischaemia

Abstract: This study show that both distal and ultradistal bypass have comparable outcome regardless of the co-morbidities. The authors believe that elderly patients should be offered ultradistal bypass if indicated to avoid major amputation.

Cited by 40 publications

References 22 publications

Comparison of angioplasty and bypass surgery for critical limb ischaemia in patients with infrapopliteal peripheral artery disease

Comparison of angioplasty and bypass surgery for critical limb ischaemia in patients with infrapopliteal peripheral artery disease

Clinical Significance of Venous Graft Size and Run-Off Segment for Peripheral Bypass Patency

The benefits of working together in diabetic foot care for the vulnerable patient

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