Infrainguinal bypass graft patency and limb salvage rates in critical limb ischemia: influence of the mode of presentation.
Rest pain, ulceration, and gangrene are often considered together in studies describing outcomes in patients with critical limb ischemia. A retrospective analysis of prospectively collected data of 152 infrainguinal bypass grafts performed on 128 patients with chronic critical limb ischemia over a 6-year period was carried out. Grafts were classified according to the mode of presentation and were followed up by regular clinical and duplex examinations. Mean follow-up period was 29 months (range 12 to 60 months). Patients' demographics, risk factors, and graft characteristics were not statistically different between the groups. The 5-year cumulative primary patency rates were 33%, 52%, and 51% for gangrene, ulceration, and rest pain, respectively (p = 0.04). The 5-year cumulative primary assisted patency rates were 46%, 70%, and 72% for gangrene, ulceration, and rest pain, respectively (p = 0.01). The 5-year cumulative secondary patency rates were 48%, 76%, and 75% for gangrene, ulceration, and rest pain, respectively (p = 0.003). The 5-year cumulative limb salvage rates were 59%, 87%, and 83%, for gangrene, ulceration, and rest pain, respectively (p = 0.01). Gangrene is a distinct subcategory of critical limb ischemia with a worse prognosis than ulceration and rest pain and should be classified as such when reporting results of infrainguinal bypass grafts.
Nasr
M K
MK
Department of Vascular Surgery, Royal United Hospital, Bath, UK.
McCarthy
R J
RJ
Budd
J S
JS
Horrocks
M
M
D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005734:Gangrene / Q000209:etiology / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000150:complications*; D007871:Leg Ulcer / Q000209:etiology / Q000601:surgery; D023821:Limb Salvage / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply* / Q000473:pathology; D008297:Male; D010146:Pain / Q000209:etiology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D014654:Vascular Patency