Popliteal-to-distal bypass for limb salvage.
A retrospective study was carried out to examine the patency and limb salvage rates of popliteal-to-distal bypass and compare the results of diabetic to those of nondiabetic patients and elective versus emergency procedures. From January 1990 to December 2001, 71 popliteal-to-distal bypasses were performed. Indications for surgery were rest pain, tissue loss, and acute ischemia, including extensive post-traumatic tibial lesions. Survival, graft patency, and limb salvage rates were determined according to the life-table method. The log-rank test was used to compare diabetic versus nondiabetic patients, elective versus emergency procedures, and saphenous vein bypass versus PTFE bypass. Postoperative primary patency, secondary patency, and limb salvage rates at 30 days were 88.7%, 91.4%, and 87%, respectively. Postoperative mortality was 2.8%, with one case of acute myocardial ischemia and one multiorgan failure. Life-table analysis showed primary and secondary patency rates of 57% and 61%, respectively, a limb salvage rate of 64%, and survival of 77% at 5 years Log-rank testing showed no statistical difference between diabetic and nondiabetic patients, whereas a statistical difference was observed in elective versus emergency procedures (p < 0.005) and great saphenous vein versus PTFE graf (p < 0.05). These results show that popliteal-to-distal bypass is a safe and effective procedure with good long-term patency and limb salvage rates in selected cases.
Grego
Franco
F
Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy. franco.grego@unipd.it
Antonello
Michele
M
Stramana
Rudi
R
Deriu
Giovanni P
GP
Lepidi
Sandro
S
D000368:Aged; D000714:Anastomosis, Surgical; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D007558:Italy; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D016019:Survival Analysis; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene