Pedal bypass grafting in the treatment of chronic critical limb ischemia



Year of publication 2007
Type Article in Periodical
Magazine / Source Scripta Medica Brno
MU Faculty or unit

Faculty of Medicine

Field Surgery incl. transplantology
Keywords pedal bypass; diabetic gangrene; chronic critical limb ischemia
Description Aim. Pedal runoff vessels are not always visible on preoperative arteriograms. In this study the long term patency of pedal grafts was evaluated in relation to whether, preoperatively, the pedal arteries were visualized by angiography or not and were only detected by duplex ultrasound. Methods. In 2000 to 2005, 81 pedal bypass grafts were performed in patients with chronic critical lower limb ischemia, of which 54 (66.7 %) had diabetes. Tissue loss was recorded in 68 (84.0 %) limbs and rest pain 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. The patients were followed up according to a standard graft surveillance program including clinical and color Doppler-ultrasound examination at 1 and 2 months postoperatively, and then once every 6 months. Results. During the follow up (median 17 months; range, 3 to 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 the risk of graft occlusion was found between the patients with visible and those with invisible pedal arteries on preoperative arteriograms (Fishers exact test). Conclusion. Pedal bypass grafting is a safe method with good long term outcomes. Duplex ultrasonography is a reliable modality for detection of pedal arteries invisible on arteriograms and it helps reduce the number of patients with nonoperable arterial occlusion disease by about 25 %.

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