title: Distal versus ultradistal bypass grafts: amputation-free survival and patency rates in patients with critical leg ischaemia.
abstract: OBJECTIVE
  Compare the outcome of distal (bypass to the crural arteries) versus ultradistal (bypass to the pedal arteries) bypasses in patients with critical leg ischaemia (CLI).
  
  
  METHODS
  Retrospective analysis of prospectively collected data of patients with CLI undergoing infra-popliteal bypass surgery is performed.
  
  
  METHODS
  Patients undergoing infra-popliteal bypass at a single institution between 2004 and 2010 are included. Patency rates at 1-year and amputation-free survival at 12 and 48 months are analysed.
  
  
  RESULTS
  Two hundred and thirty bypasses were performed in 209 consecutive patients (156 men, median age; 76 years, range; 19-96 years). One hundred and seventy nine (78%) bypass were classified as distal and 51 (22%) as ultradistal. The incidence of diabetes mellitus was significantly higher in the ultradistal group (p=0.0025). At 1-year, the distal group primary, assisted-primary and secondary patency rates were 61.7%, 83.1% and 87.4% compared to 61.9%, 87.4% and 87.4% in the ultradistal group respectively. Amputation-free survival at 12 and 48 months was 82.9% and 61.5% in the distal group compared to 83.0% and 64.9% in the ultradistal group.
  
  
  CONCLUSIONS
  This study show that both distal and ultradistal bypass have comparable outcome regardless of the co-morbidities. The authors believe that elderly patients should be offered ultradistal bypass if indicated to avoid major amputation.
authors.affiliation: King's Health Partners Vascular Unit, King's College, Guy's and St Thomas' Hospitals, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Slim
authors.forename: A
authors.initials: A
authors.lastname: Tiwari
authors.forename: A
authors.initials: A
authors.lastname: Ahmed
authors.forename: J C
authors.initials: JC
authors.lastname: Ritter
authors.forename: H
authors.initials: H
authors.lastname: Zayed
authors.forename: H
authors.initials: H
authors.lastname: Rashid
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D015897:Comorbidity; D016638:Critical Illness; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008131:London; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014654:Vascular Patency; D055815:Young Adult