Pedal bypass grafting on arteriographically invisible foot arteries detected by duplex ultrasound for limb salvage.
| Authors | |
|---|---|
| Year of publication | 2007 |
| Type | Article in Periodical |
| Magazine / Source | Minerva Chirurgica |
| MU Faculty or unit | |
| Citation | |
| Field | Surgery incl. transplantology |
| Keywords | Vascular surgical procedures; Pedal bypass; Peripheral arterial disease; Angiography; Ultrasonography; duplex |
| Description | Aim. In this study the long term outcomes in patients undergoing pedal bypass grafting were evaluated and the risk of graft occlusion was related to whether, preoperatively, the pedal arteries were visualized by angiography or not and were only detected by duplex ultrasography. Methods. In 2000 - 2005, 81 pedal bypass grafts were performed in patients with chronic critical lower limb ischemia, of which 54 (66.7 %) had diabetes. Tissue loss (SVS/ISCVS - category 5) was recorded in 68 (84.0 %) limbs and rest pain (SVS/ISCVS - category 4) in 13 (16.0 %) limbs. In 24 limbs (29.6 %) bypass grafts were implanted on the pedal arteries that had not been visualized by preoperative angiography, but had been detected only by duplex ultrasound. Results. During the follow up (median, 17 months; range, 3 - 69 months), 18 grafts (22.2 %) failed. Seven limbs had to be treated by early thrombectomy, which resulted in long term graft patency and limb salvage. The early postoperative mortality rate was 2.5 %. Cumulative primary and secondary graft patency rates, and limb salvage rates were 70.2 %, 80.2 % and 82.4 %, respectively. No significant difference in graft occlusion was found between the patients with visible and those with not visible pedal arteries on preoperative arteriograms (Fishers exact test). Conclusion. Duplex ultrasonography is a reliable modality for detection of target pedal arteries not visualized by preoperative arteriography and it helps reduce the number of patients with non-operable arterial occlusion disease by about 25 %. |
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