Outcome and cost analysis after femorocrural and femoropedal grafting for critical limb ischaemia

Abstract

The patency rate of femorotibial and peroneal bypass depends on the inflow state, the availability of a venous conduit, the number of calf vessels, the presence of straight flow to the foot and the presence of patent pedal vessels. These factors can help in the selection of patients for femorodistal reconstruction and may explain the wide variation in published results. The low cost of revascularization compared with amputation justifies attempted reconstruction. However, repeated attempts to reconstruct patients with severe distal disease who may benefit more from primary amputation will significantly increase the cost.

Diabetes and Vascular Disease

“…Graft patency rates are similar in diabetic and nondiabetic patients after surgical revascularization; however, there is a greater rate of limb loss in diabetic patients with critical limb ischemia because of persistent foot infection and necrosis. 73,74 Also, the risk of perioperative cardiovascular events is increased in patients with diabetes. 75,76 Carotid Artery Revascularization The indications for carotid artery revascularization are the same in diabetic and nondiabetic patients.…”

Popliteo–pedal bypass surgery for critical limb ischemia

“…Symptomatic PVD is not a benign condition as up to 50% of those diagnosed will be dead within 10-years [4]. Aggressive attempts to revascularise should be considered for those with end-stage PVD as these have been shown to be cost effective [5,6]. In addition, a major limb amputation carries a 2-year survival of 50% and just 29% will be alive 5-years after amputation [7,8].…”

An aggressive policy of bilateral saphenous vein harvest for infragenicular revascularisation in the era of multidrug resistant bacteria

“…Venovenous composite grafts have excellent reported long term patency (two year secondary patency rates of 62%-83% 2 8 9 ) and the presence of a venovenostomy is not associated with reduced patency compared with reversed vein without venovenostomy. 2 No patient subsequently required harvesting of the contralateral LSV for coronary or peripheral revascularisation. This is due to several reasons.…”

“…O ver the past two decades, bypass grafts to the infragenicular arteries have been shown to be effective in the management of patients with chronic critical limb ischaemia with secondary patency rates and limb salvage rates of 45%-64% and 54%-84% respectively at three years. [1][2][3] Several factors have been identified which determine the success of the procedure, including the preferential use of long saphenous vein (LSV) as a bypass conduit, 4 the use of intraoperative digital subtraction angiography (DSA) 5 to identify a suitable distal vessel, and effective postoperative graft surveillance. 6 The success of infragenicular revascularisation is, however, limited by several factors one of which is the high proportion of patients without LSV of adequate length or quality.…”