Crural Bypass for Critical Lower Limb Ischemia with Omniflow II Prosthesis.
Background Reports about the use of the Omniflow II prosthesis (Bio Nova International, Victoria, Australia) in a crural position in patients with critical lower limb ischemia are rare. Methods All crural bypass operations were registered in a database. Primary end points of the study were amputation-free survival, limb salvage, and long-term patency. Results From January 2007 to December 2012, we implanted 27 Omniflow II prostheses in the crural position for critical lower limb ischemia. Of these, 12 crural bypasses were conducted with adjuvant distal arteriovenous fistula as a means to increase bypass flow in the presence of severely impaired intraoperative runoff or revision for early failure. Fifteen Omniflow II prosthesis bypasses were performed in the crural position without fistula. Overall, two patients died postoperatively. The limb salvage rate was 92% in the fistula group compared with 60% in the nonfistula group after a median observation time of 19 months in patients getting Omniflow prosthesis bypasses. Conclusion Omniflow II prosthesis in patients with critical lower limb ischemia and absence of sufficient autologous vein is durable. Moreover, the use of adjuvant distal arteriovenous fistula may increase the chance of limb salvage in this group of patients.
Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany.
Friedrich
F
Dünschede
Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany.
Justina
J
Stabrauskaite
Department of Medicine 2, University Hospital Mainz, Medical Center, Mainz, Germany.
Gerhard
G
Weisser
Department of Medicine 2, University Hospital Mainz, Medical Center, Mainz, Germany.
Christine
C
Espinola-Klein
Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany.
Bernhard
B
Dorweiler
Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany.
Christian-Friedrich
CF
Vahl
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016638:Critical Illness; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency