Inframalleolar bypass for chronic limb-threatening ischemia

Abstract

The aims of this study were to analyze the results of inframalleolar bypass for chronic limb-threatening ischemia (CLTI) and to identify outcome-predicting factors. All consecutive patients undergoing inframalleolar bypass for CLTI between 2015 and 2018 were included in this retrospective, single-center study. Outflow artery was the most proximal patent vessel segment in continuity with inframalleolar arteries. Bypasses originating from the popliteal artery were defined as ‘short bypasses’. Sixty patients underwent inframalleolar bypass, with four patients undergoing bilateral procedures, making a total of 64 limbs included. The mean age was 73 ± 14 and 52 (81%) were male. The great saphenous vein was the preferred conduit ( n = 58, 91%), in a devalvulated fashion ( n = 56, 88%). Superficial femoral artery was the most common inflow artery for ‘long’ grafts ( n = 22, 34%), while popliteal artery was the inflow artery for all ‘short’ grafts ( n = 25, 39%). Dorsalis pedis artery was chosen as an outflow artery in 41 patients (63%). Median follow-up was 21 months. Two-year primary and secondary patency, limb salvage, amputation-free survival, and overall survival rates were 67 ± 6%, 88 ± 4%, 84 ± 4%, 72 ± 6%, and 85 ± 4%, respectively. At multivariate analysis, dialysis was an independent predictor for poor primary patency (HR, 4.6; 95% CI, 1.62–13.05; p = 0.004), whereas a short bypass was independently associated with an increased primary patency (HR, 0.3; 95% CI, 0.10–0.89; p = 0.03). In conclusion, bypass grafting to the inframalleolar arteries resulted in good patency rates, limb salvage and overall survival. Dialysis patients had lower primary patency but still had good limb salvage and survival. Short bypass was a predictor of improved primary patency.

One-Year Follow-Up of an Inframalleolar Collateral Artery Bypass

“…However, in extreme circumstances, bypasses are also done to inframalleolar arteries such as plantar and tarsal arteries [6]. Although inframalleolar bypass is technically challenging, acceptable limb salvage rates have been reported [3]. The usual target arteries for such bypasses are dorsalis pedis, or even plantar arteries [3].…”

“…Although inframalleolar bypass is technically challenging, acceptable limb salvage rates have been reported [3]. The usual target arteries for such bypasses are dorsalis pedis, or even plantar arteries [3]. In extreme situations, bypasses are also done to the named collateral arteries such as descending genicular artery or median sural artery [7].…”

“…CLTI is often an end result of multilevel occlusive vascular disease involving multiple infra-inguinal arteries [1]. Successful revascularization and restoration of blood flow to one of the pedal arteries is the mainstay to prevent major limb amputation [3]. Here, we report a rare case of successful bypass to the inframalleolar ankle collateral artery.…”

Intensifying our focus on critical limb ischemia

“…Benedetto and colleagues report on their experience with inframalleolar bypass in patients with advanced CLI. 11 These findings emphasize the need to consider all available options when attempting limb salvage in CLI. Endovascular techniques and devices have also significantly advanced in the past few years.…”

Neutrophil-to-Lymphocyte Ratio Predicts Restenosis After Drug-Coated Balloon Therapy for Femoropopliteal Artery Lesions: A Retrospective Study

“…In lower extremity arterial disease, the femoropopliteal artery has a larger lumen and is often treated with intervention combined with drugs; meanwhile, the distal small artery intervention is more difficult, and drug therapy or surgery is mainly used ( 4 ). Benedetto et al demonstrated that inframalleolar bypass resulted in good patency rates, limb salvage and overall survival ( 5 ). Currently, two main methods are used for interventional treatment of femoropopliteal artery disease, namely, stent implantation and balloon dilation ( 4 ) followed by strict medical therapy, including long-term antiplatelet therapy and statin ( 6 ).…”