title: Tertiary patency as a measure of active revascularization policy for leg salvage.
abstract: BACKGROUND
  An active surgical strategy to save lower limbs of patients with critical leg ischemia includes not only infrainguinal bypass surgery but also repeated surgery when needed. A failed infrainguinal bypass often threatens viability of the patient's legs, at which point a redo bypass procedure with a new graft may be the only alternative to major amputation. We assessed tertiary patency, defined as the whole period of time with a patent infrainguinal graft in a leg, to illustrate future potential of limb salvage surgery after a failed bypass.
  
  
  METHODS
  A total of 593 patients with critical leg ischemia and tissue defects (Fontaine IV) who underwent infrainguinal bypass surgery between January 2000 and December 2005 at our institution were included in this retrospective study.
  
  
  RESULTS
  Secondary and tertiary patency rates were 95 ± 1% and 96 ± 3% at 1 month, 75 ± 2% and 82 ± 2% at 1 year, and 61 ± 2% and 70 ± 3% at 5 years, respectively, p = 0.003. Leg salvage rate was 94 ± 1% at 1 month, 83 ± 2% at 1 year, and 78 ± 2% at 5 years. There was no significant difference between leg salvage and tertiary patency rates, p = 0.281.
  
  
  CONCLUSIONS
  Tertiary patency rate was higher than the secondary patency rate. This result might reflect active limb salvage surgery with satisfactory results. The absence of a gap between tertiary patency and leg salvage rates indicates the importance of a patent infrainguinal bypass graft to save lower limbs of patients with ischemic tissue defects.
authors.affiliation: Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. maria.soderstrom@hus.fi
authors.forename: Maria
authors.initials: M
authors.lastname: Söderström
authors.forename: Eva
authors.initials: E
authors.lastname: Arvela
authors.forename: Maarit
authors.initials: M
authors.lastname: Venermo
authors.forename: Mauri
authors.initials: M
authors.lastname: Lepäntalo
authors.forename: Anders
authors.initials: A
authors.lastname: Albäck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016638:Critical Illness; D005260:Female; D005387:Finland; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects