Pedal Bypass Grafting in the Treatment of Chronic Critical Lower Limb Ischaemia



Rok publikování 2012
Druh Vyžádané přednášky
Fakulta / Pracoviště MU

Lékařská fakulta

Popis Introduction. The patients who underwent pedal bypass grafting during the last decade were evaluated. Methods. 110 pedal bypass procedures were carried out in patients with chronic critical lower limb ischaemia. The group included 82 men and 28 women with an average age of 67 (range, 28-84) years. Of them, 73 (66.4%) had diabetes. Gangrene or tissue loss was diagnosed in 93 limbs (84.5%), rest pain was recorded in eight (7.3%). The data were statistically analysed to assess the influence of patient diabetes, pedal bypass length, distal anastomosis placement, and spliced graft use on the long-term results. Using Kaplan-Meier survival analysis, primary and secondary bypass patency and the limb salvage rates were evaluated in the whole patient group and in the patient sub-groups. The results between the relevant sub-groups were compared using the Log Rank test (confidence intervals 95%, level of significance a=0.05) (Figure 1). Results. Healing of the wound was achieved in all limbs with functioning bypass. In four limbs it was necessary to use a free muscle flap. At follow-up (average, 30 +- 26.4 months; range, 1.2 - 91.2 months), bypass occlusion occurred in 21 limbs; in eight of these, it was managed by early intervention. The 30-day post-operative mortality as 1.8%. The cumulative primary and secondary patency rates were 67.2% and 69.5%, respectively; the cumulative probability of limb salvage was 78.0%. Diabetes mellitus has no influence on long-term bypass patency and limb salvage. Shorter bypass grafts showed higher both primary and secondary patency rates. The distal anastomosis placement did not affect long-term results, but the use of spliced grafts had adverse effects on the bypass primary patency. Conclusion: Pedal bypass grafting is an effective and safe method achieving very good long-term results in the treatment of chronic critical lower limb ischaemia.

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