Pedal Bypass in Salvage of Critically Ischemic Limb with Unsatisfactory Preoperative Angiography
| Authors | |
|---|---|
| Year of publication | 2005 |
| Type | Article in Periodical |
| Magazine / Source | Interactive CardioVascular and Thoracic Surgery, Current Contents |
| MU Faculty or unit | |
| Citation | |
| Field | Cardiovascular diseases incl. cardiosurgery |
| Keywords | pedal bypass - chronic critical lower limb ischemia - diabetic foot gangrene - limb salvage |
| Description | Objective: The cause of chronic critical lower limb ischemia is often the combination of diabetic angiopathy and atherosclerotic disease of crural arteries. Foot gangrene is the terminal stage in this cases and the pedal bypass grafting is often the only method of limb salvage. Methods: In 2000 to 2004, 64 pedal bypasses were performed in 63 patients with chronic critical lower limb ischemia. Fifty-six (87.5 %) patients had gangrene or ischemic ulcer, 44 (69.8 %) had diabetes. In some of the patients (17.2 %), previous percutaneous transluminal angioplasty of the crural arteries had failed. Preoperative angiographic findings were unsatisfactory in the majority of the patients; the pedal arch was not visualized in 40 (62.5 %) limbs. The cumulative primary and secondary graft patency rates and limb-salvage rate were assessed by Kaplan-Meiers survival analysis. Fishers exact test was used to investigate whether the absence of the pedal arch on preoperative arteriograms was related to an increased risk of graft occlusion. Results: During 60 months of follow-up, 14 grafts (22 %) failed. Early thrombectomy resulting in long-term graft patency salvaged 8 limbs. One limb with graft occlusion, occurring after foot ulcer had healed, was also salvaged. However, one amputation had to be performed despite a patent graft. The perioperative mortality rate was 3.2 %. Cumulative primary and secondary graft patency rates and limb-salvage rates at 60 months were 75 %, 79 % and 82 %, respectively. The 14 occluded grafts were recorded in nine limbs (22.5 %) that, on preoperative arteriograms, had no visible pedal arch (n=40) and in five limbs (20.8 %) with a visible pedal arch (n=24). The difference in the risk of graft occlusion between these two groups was not significant (Fishers exact test, P=1.000). Conclusions: Pedal bypass grafting is a safe method with good long-term outcomes. Since the absence of the pedal arch on preoperative arteriograms does not increase the risk of graft occlusion, unsatisfactory preoperative angiographic findings need not be taken as a contraindication to pedal vascular reconstruction. |
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