title: Results of peripheral bypass surgery in patients with critical limb ischemia (CRITISCH registry).
abstract: OBJECTIVE
  On the basis of the CRITISCH registry outcomes in patients with critical limb ischemia (CLI) undergoing lower extremity bypass surgery were analyzed according to the site of distal anastomosis and type of bypass material.
  
  
  METHODS
  A total of 284 patients with lower extremity bypasses consisting of 75 patients with bypasses above the knee (group 1), 80 with bypasses below the knee (group 2) and 129 crural or pedal bypasses (group 3) were included in the study. Altogether, 159 autologous saphenous vein grafts and 125 synthetic grafts were used.
  
  
  RESULTS
  There were no perioperative complications in 191 out of the 284 patients (67.3 %) and 236 of the 284 patients (83.1 %) had open bypasses at hospital discharge. An uneventful postoperative course was observed in 76 % of the patients in group 1, 62.5 % in group 2 and 65.1 % in group 3. Amputation-free survival was 86 % at 1 year in group 1, 65 % in group 2 and 69 % in group 3. For bypasses above the knee synthetic grafts were at least not inferior to vein grafts (amputation-free survival at 1 year: prosthetic bypasses 92 % and saphenous vein grafts 71 %,p= 0.147), whereas in the crural/pedal bypass group vein grafts showed better amputation-free survival at 1 year (76 %) compared with synthetic bypasses (56 %,p= 0.105). Patients with a PREVENT III (PIII) CLI risk score ≤3 exhibited better amputation-free survival at 1 year (78 %) compared to patients with a PIII CLI risk score of 4-7 (69 %,p= 0.053). The same applied to patients with Rutherford class 4 vs. Rutherford class 6 CLI.
  
  
  CONCLUSIONS
  In patients with CLI and above-knee bypasses, vein grafts confer no benefits compared with synthetic grafts for at least 1 year follow-up; however, in the case of more distal anastomoses vein grafts should be preferred.
authors.affiliation: Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum and St. Franziskus Hospital Münster, Münster, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Bisdas
authors.affiliation: Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum and St. Franziskus Hospital Münster, Münster, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Torsello
authors.affiliation: Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum and St. Franziskus Hospital Münster, Münster, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Stachmann
authors.affiliation: Deutsches Institut für Gefäßmedizinische Gesundheitsforschung (DIGG) of the DGG, Berlin, Germany ; Wiss. Koordinator DIGG, In den Grüben 144, 84489 Burghausen, Germany.
authors.forename: R T
authors.initials: RT
authors.lastname: Grundmann
keywords: Amputation-free survival; Autologous vein; Bypass surgery; Critical limb ischemia; Prosthetic graft