Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492009000400003
Jornal Vascular Brasileiro
Original Article

Are femorodistal bypass grafts for acute limb ischemia worthwhile?

Nader Khandanpour; Felicity J. Meyer; Lily Choy; Jane Skinner; Matthew P. Armon

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Abstract

Background: It has been shown that autogenous veins are associated with the best limb salvage rates for femorodistal bypass surgery. However, in emergency settings, when an autogenous vein is unavailable, use of synthetic graft material or amputation is a critical decision to make. Objective: To assess the appropriateness of femorodistal bypass grafts for acute limb ischemia in emergency settings. Methods: Patients who underwent emergent bypass and elective femorodistal bypass surgery between 1996 and 2006 were reviewed retrospectively in a single center. Results: There were 147 patients of which 84 had elective and 63 had emergent bypass. The graft patency rates for elective admissions were 44 and 25% vs. 25 and 23% for admissions for acute femorodistal graft surgery at 2 and 4 years, respectively (p < 0.004). Admissions for acute ischemia who were treated with prosthetic grafts had a primary patency of 24 vs. 27% for vein grafts at 2 years and 24 vs. 23% at 4 years (p = 0.33). In the acute femorodistal grafts group, primary patency at 2 years for vein and prosthetic grafts was 27 and 24% as compared to 42 and 32% for electives. These values for cumulative limb salvage rates for elective bypasses were 73 and 63% as compared to 52% at both time points in the acute femorodistal graft group (p < 0.004). In emergency settings, the limb salvage rate for acute femorodistal bypass with prosthetic grafts was 38%, and for vein grafts it was 62% at both time points (p = 0.08). Conclusion: The long term limb salvage rate of 38% suggests that emergent femorodistal revascularization is worthwhile.

Keywords

Mode of admission, femorodistal, bypass graft, vascular surgery

References

Kunlin J. Long vein transplantation in treatment of ischemia caused by arteritis. Rev Chir. 1951;70:206-35.

Campbell CD, Brooks DH, Webster MW, Diamond DL, Peel RL, Bahnson HT. Expanded microporous polytetrafluoroethylene as a vascular substitute: a two year follow-up. Surgery. 1979;85:177-83.

Eskelinen E, Lepäntalo M, Hietala EM. Lower limb amputations in Southern Finland in 2000 and trends up to 2001. Eur J Vasc Endovasc Surg. 2004;27:193-200.

Quiñones-Baldrich WJ, Busuttil RW, Baker JD. Is the preferential use of polytetrafluoroethylene grafts for femoropopliteal bypass justified?. J Vasc Surg. 1988;8:219-28.

Pereira CE, Albers M, Romiti M, Brochado-Neto FC, Pereira CA. Meta-analysis of femoropopliteal bypass grafts for lower extremity arterial insufficiency. J Vasc Surg. 2006;44:510-7.

Aracil-Sanus E, Mendieta-Azcona C, Cuesta-Gimeno C, Chinchilla-Molina A. Infrageniculate bypass graft for limb salvage using polytetrafluoroethylene and distal vein cuff as the first alternative in patients without ipsilateral greater saphenous vein. Ann Vasc Surg. 2005;19:379-85.

Berglund J, Björck M, Elfström J. SWEDVASC Femoro-popliteal Study Group: Long-term results of above knee femoro-popliteal bypass depend on indication for surgery and graft-material. Eur J Vasc Endovasc Surg. 2005;29:412-8.

Luther M. Treatment of chronic critical leg ischaemia: a cost benefit analysis. Ann Chir Gynaecol Suppl. 1997;213:1-142.

Karacagil S, Almgren B, Bowald S, Eriksson I. Bypass grafting to the popliteal artery in limbs with occluded crural arteries. Am J Surg. 1991;162:19-23.

Panetta TF, Marin ML, Veith FJ. Unsuspected preexisting saphenous vein disease: an unrecognized cause of vein bypass failure. J Vasc Surg. 1992;15:102-10.

Davies AH. Vein factors that affect the outcome of femorodistal bypass. Ann R Coll Surg Engl. 1995;77:63-6.

Kersting S, Ockert D, Zimmermann T, Meichelbock W, Saeger HD, Bergert H. Infragenicular polytetrafluoroethylene bypass with tapered versus straight vascular grafts: results from a prospective multicenter cohort study. Ann Vasc Surg. 2004;18:440-7.

Feinglass J, Pearce WH, Martin GJ. Postoperative and amputation-free survival outcomes after femorodistal bypass grafting surgery: findings from the Department of Veterans Affairs National Surgical Quality Improvement Program. J Vasc Surg. 2001;34:283-90.

Watson HR, Schroeder TV, Simms MH, Horrocks M. Association of sex with patency of femorodistal bypass grafts. Eur J Vasc Endovasc Surg. 2000;20:61-6.

Rutherford RB, Baker JD, Ernst C. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 2001;33:805.

Donaldson MC, Whittemore AD, Mannick JA. Further experience with an all-autogenous tissue policy for infrainguinal reconstruction. J Vasc Surg. 1993;18:41-8.

Bastounis E, Georgopoulos S, Maltezos C, Alexiou D, Chiotopoulos D, Bramis J. PTFE-vein composite grafts for critical limb ischaemia: a valuable alternative to all-autogenous infrageniculate reconstructions. Eur J Vasc Endovasc Surg. 1999;18:127-32.

Taylor LM, Edwards JM, Porter JM. Present statues of reversed vein bypass grafting: five-year results of a modern series. J Vasc Surg. 1990;11:193-206.

Donaldson MC, Whittemore AD, Mannick JA. Further experience with man all autogenous vein policy for infrainguinal reconstruction. J Vasc Surg. 1993;18:41-8.

Hobson RW 2nd, O’Donnell JA, Jamil Z, Mehta K. Below-knee bypass for limb salvage: Comparison of autogenous saphenous vein, polytetrafluoroethylene, and composite dacron-autogenous vein grafts. Arch Surg. 1980;115:833-7.

Harris JP, O’Brien CJ, Stephen MS, Sheil AG, May J. Should polytetrafluoroethylene grafts be used in preference to saphenous vein for femoropopliteal arterial bypass?. Aust N Z J Surg. 1985;55:579-83.

Panayiotopoulos YP, Edmondson RA, Reidy JF, Taylor PR. A scoring system to predict the outcome of long femorodistal arterial bypass grafts to single calf or pedal vessels. Eur J Vasc Endovasc Surg. 1998;15:380-6.

Murphy GJ, Kipgen D, Dennis MJ, Sayers RD. An aggressive policy of bilateral saphenous vein harvest for infragenicular revascularisation in the era of multidrug resistant bacteria. Postgrad Med J. 2002;78:339-43.

Flinn WR, Rohrer MJ, Yao JS, McCarthy WJ, Fahey VA, Bergan JJ. Improved long-term patency of infra-genicular polytetrafluoroethylene grafts. J Vasc Surg. 1988;7:685-90.

Whittemore AD, Kent KC, Donaldson MC, Couch NP, Mannick JA. What is the proper role of polytetrafluoroethylene grafts in infra-inguinal reconstruction?. J Vasc Surg. 1989;10:299-305.

Griffiths GD, Nagy J, Black D, Stonebridge PA. Randomized clinical trial of distal anastomotic interposition vein cuff in infrainguinal polytetrafluoroethylene bypass grafting. Br J Surg. 2004;91:560-2.

Conte MS, Belkin M, Upchurch GR, Mannick JA, Whittemore AD, Donaldson MC. Impact of increasing comorbidity on infrainguinal reconstruction: a 20-year perspective. Ann Surg. 2001;233:445-52.

Raviola CA, Nichter LS, Baker JD, Busuttil RW, Machleder HI, Moore WS. Cost of treating advanced leg ischemia: Bypass graft vs primary amputation. Arch Surg. 1988;123:495-6.

Gupta SK, Veith FJ, Ascer E, Flores SA, Gliedman ML. Cost factors in limb-threatening ischaemia due to infrainguinal arteriosclerosis. Eur J Vasc Surg. 1988;2:151-4.

Mackey WC, McCullough JL, Conlon TP. The costs of surgery for limb-threatening ischemia. Surgery. 1986;99:26-35.

Ouriel K, Fiore WM, Geary JE. Limb-threatening ischemia in the medically compromised patient: amputation or revascularization?. Surgery. 1988;104:667-72.

Friedman SG, Kerner BA, Friedman MS, Moccio CG. Limb salvage in elderly patients: Is aggressive surgical therapy warranted?. J Cardiovasc Surg (Torino). 1989;30:848-51.

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