title: Is infrainguinal bypass grafting successful following failed angioplasty?
abstract: OBJECTIVE
  Angioplasty is often used in the management of lower limb ischaemia and can reduce the need for infrainguinal bypass in some patients. There is an associated failure rate with this technique and bypass surgery is often used in this situation as a secondary limb salvage procedure. We aimed to evaluate the outcome of infrainguinal bypass grafting following failed attempt at angioplasty.
  
  
  METHODS
  All cases of infrainguinal bypass at a single centre over a seven year period were identified and notes reviewed. Cases were divided into four groups according to their indication for surgery; acute ischaemia, chronic critical ischaemia, failed angioplasty and an 'other' group including aneurysmal disease and claudicants. The failed angioplasty group was compared with the other three groups. Survival analysis was performed using Kaplan Meier curves and groups compared in terms of long term patency and survival.
  
  
  RESULTS
  Primary patency was 61.2% in the failed angioplasty group at 12 months compared with 60.6% in the other groups (P=1.11). There was also no significant difference in primary patency at 60 months (50% vs 40.6%, P=0.26). Survival at 12 months was also comparable between the groups (failed angioplasty group 74.2% compared with 77.3% in the other groups, P=0.662) as was 60 months survival (33.3% and 35.4% respectively, P=0.166).
  
  
  CONCLUSIONS
  In this study, outcome of infrainguinal bypass following failed angioplasty was comparable to outcome of surgery performed for another indication. This paper supports the use of distal bypass surgery for limb salvage in cases where minimal access techniques have failed.
authors.affiliation: Vascular Surgery group, Department of Cardiovascular Sciences, University of Leicester, Level 2 RKCSB, Leicester Royal Infirmary, Leicester LE2 7LX, UK. bex125@hotmail.com
authors.forename: R M
authors.initials: RM
authors.lastname: Sandford
authors.forename: M J
authors.initials: MJ
authors.lastname: Bown
authors.forename: R D
authors.initials: RD
authors.lastname: Sayers
authors.forename: J N
authors.initials: JN
authors.lastname: London
authors.forename: A R
authors.initials: AR
authors.lastname: Naylor
authors.forename: M J
authors.initials: MJ
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D017211:Treatment Failure; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency / Q000502:physiology