Pedal bypass for limb-threatening ischaemia: An 11-year review

Abstract

Fifty-six patients with limb-threatening ischaemia had pedal revascularization with either autologous vein (n = 39) or sequential composite graft with a 6-mm polytetrafluoroethylene prosthesis and autologous vein (n = 17); 75 per cent had gangrene and skin necrosis and 25 per cent had ischaemic rest pain alone. Twelve grafts occluded within the first week, and resulted in major amputation in eight patients after unsuccessful revision. Two patients required amputation for persistent ischaemia despite a patent bypass. One patient died from bowel perforation (2 per cent). In 47 (84 per cent) of the 56 patients limb and life were preserved. The primary patency rate after 1, 2 and 4 years was 65, 55 and 55 per cent respectively, the secondary patency rate was 71, 62 and 62 per cent, and cumulative limb salvage rates were 77, 71 and 66 per cent. Life-table survival rates during follow-up (median 25 (range 0-112) months) were 89, 78 and 52 per cent respectively after 1, 2 and 4 years. Thirteen of 21 patients who died during follow-up did not require major amputation. Pedal reconstruction with autologous vein provides limb salvage until death in nearly two-thirds of patients with critical limb ischaemia resulting from crural arterial occlusive disease.

Popliteo–pedal bypass surgery for critical limb ischemia

“…These results demonstrate that popliteo-pedal bypass surgery as performed in our vascular unit is comparable with worldwide results [9][10][11] in terms of overall survival and primary patency rates. Our primary patency rate of 63.3% at 5-years compares favourably with other published results [14][15][16][17][18] including the recently published meta-analysis [19] which quoted a 5-year pooled primary patency rate of 63.1% and also a larger study of inframalleolar bypasses [20].…”

“…Overall survival in our patient population with multiple co-morbidities is equivalent to other major studies [9][10][11][14][15][16][17][18]. Long-term survival results for endovascular intervention are still awaited.…”

“…Various studies [9][10][11] have shown that even in those with very extensive disease, but patent foot arteries, bypass surgery is an effective treatment for limb salvage. More recently, the use of angioplasty has become much more prevalent with encouraging early results.…”

Role of Infrainguinal Angioplasty in the Treatment of Critical Limb Ischaemia

“…the comparisonbetween endovascular and surgical series seems to be skewed by dissimilarity of the groups treated. this is illustrated by the different patency and leg salvage gaps in surgical and endovascular series (16,18,25,26,29,(41)(42)(43)(44)(45)(46)(47)(48). It is unclear whether these data suggest different severity of ischaemia treated or only that the revascularisation is needed to stay open for the period of ulcer healing.…”

Gefäßchirurgische Therapiemöglichkeiten beim diabetischen Fußsyndrom (DFS)

“…[11] prägnanter, daß retrospektiv über 11 Jahre durch pedale Gefäßrekonstruktionen nahezu zwei Drittel der Patienten bis zu Ihrem Tode vor einem Extremitätenverlust bewahrt werden konnten. al.…”