title: Popliteo-pedal bypass surgery for critical limb ischemia.
abstract: BACKGROUND
  Critical limb ischaemia due to distal arterial disease represents a significant challenge. Randomised controlled evidence suggests that open surgery may be superior to endovascular intervention but there is limited data on the specific clinical cohort with exclusively infra-popliteal disease.
  
  
  OBJECTIVE
  We analysed indications for, and outcome from all, popliteo-pedal bypass procedures performed between July 1998 to November 2008.
  
  
  METHODS
  Twenty-eight bypass procedures were performed in 24 patients. Autologous vein was used exclusively. The proximal anastomosis was to the below-knee popliteal artery in all the patients; the distal anastomosis was to plantar artery (n = 15) or dorsalis pedis artery (n = 13). Mean patient age was 63.Eight years of age (range 37-92 years). Indications for surgery were tissue loss (n = 21) and rest pain (n = 7). Ultrasound graft surveillance was performed every 6-months.
  
  
  RESULTS
  Using life table analysis, primary graft patency was 63.3% at 1-, 3- and 5-years and secondary patency (after three interventions) was 74.6% at 1-, 3- and 5-years. Limb salvage rate was 81.8% after 1-, 3- and 5-years as all five limb amputations were performed in the first 3-months following the surgery. Overall survival was 75, 75 and 47.1% at 1-, 3- and 5-years, respectively. The major amputation free survival rate was 54.2, 54.2 and 21.3% at 1-, 3- and 5-years, respectively. Seventy-nine percent (n = 19) patients were diabetic.
  
  
  CONCLUSIONS
  Our data supports popliteo-pedal bypass as an effective treatment for distal vascular disease. Comparison with endovascular treatment in a randomised trial needs to be performed.
authors.affiliation: AMNCH, Tallaght Hospital, Tallaght, Dublin 24, Ireland.
authors.forename: D W
authors.initials: DW
authors.lastname: Good
authors.forename: Hasan
authors.initials: H
authors.lastname: Al Chalabi
authors.forename: H
authors.initials: H
authors.lastname: Al Chalabi
authors.forename: F
authors.initials: F
authors.lastname: Hameed
authors.forename: B
authors.initials: B
authors.lastname: Egan
authors.forename: S
authors.initials: S
authors.lastname: Tierney
authors.forename: T M
authors.initials: TM
authors.lastname: Feeley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D005260:Female; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000601:surgery*; D011150:Popliteal Artery / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome