title: Below-knee revascularization in patients with critical limb ischemia: long-term comparison of redo vs primary interventions.
abstract: OBJECTIVE
  The aim of this study was to evaluate the authors' experience in below-knee revascularization in patients with critical limb ischemia, comparing long-term outcomes in primary and secondary interventions.
  
  
  METHODS
  From January 2000 to December 2006, 140 consecutive below-knee revascularizations in patients with critical limb ischemia were performed at the Department of Vascular Surgery of the University of Florence (Italy). In 105 patients (75%) a primary intervention was performed (Group 1). Early and long-term results in terms of survival, patency and limb salvage were compared with those obtained in the remaining 35 patients (25%) secondarily operated on in the same period for a late (>30 days) bypass graft thrombosis (Group 2).
  
  
  RESULTS
  One patient died in the early postoperative period. Thirty-day thrombosis and amputation rates were poorer in Group 2 than in Group 1 (17.1% and 4.8%, P=0.02; 37.1% and 16.2%, P=0.01, respectively). Mean duration of follow-up was 25.1 months. At 60 months there were no differences between the two groups in terms of survival (90.1% in Group 1 and 90.9% in Group 2; P=NS), primary patency (43.5% in Group 1 and 31.9% in Group 2; P=NS) and secondary patency (48.4% in Group 1 vs 43.8% in Group 2; P=NS). Estimated 60-month limb salvage rate was significantly poorer in Group 2 than in Group 1 (64.1% and 77.7%, respectively; P=0.05). In Group 2 prosthetic graft material significantly affects 60-month limb salvage rate.
  
  
  CONCLUSIONS
  Redo below-knee revascularization in patients with critical limb ischemia provides acceptable long-term results in terms of primary and secondary patency; however, limb salvage appeared to be slightly worse in patients undergone redo surgery.
authors.affiliation: Department of Vascular Surgery, University of Florence, Florence, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Troisi
authors.forename: W
authors.initials: W
authors.lastname: Dorigo
authors.forename: G
authors.initials: G
authors.lastname: Pratesi
authors.forename: A
authors.initials: A
authors.lastname: Alessi Innocenti
authors.forename: R
authors.initials: R
authors.lastname: Pulli
authors.forename: C
authors.initials: C
authors.lastname: Pratesi
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D016638:Critical Illness; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D012042:Registries; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation*; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency