Re-intervention after vascular surgery for critical leg ischaemia.

Re-operation after arterial bypass in the leg is common, may be seen as failure by many and can appear expensive to budget holders. Secondary reconstruction may not be undertaken for these reasons. The indications for and outcome of further intervention have been studied in 395 primary presentations with critical leg ischaemia, all of whom underwent arterial reconstruction. During the study period the primary amputation rate was 3%, and 10% of reconstructed patients presented with skin necrosis or gangrene. One hundred and twenty-nine reconstructions (32%) were to crural vessels in the lower third of the calf. Mean follow-up was 3 years, 1 month mortality was 2% and overall mortality 20%. One hundred and seventy-three (44%) patients required further intervention: 118 (30%) for recurrence of ipsilateral ischaemic symptoms and 55 (14%) in the presence of a patent primary graft (mostly operations on the contralateral leg). A total of 695 secondary operations were required over follow-up, a mean 1.75 additional operations per patient per 3 years. Following recurrence of ischaemia, graft revision or secondary revascularisation was undertaken in 98 of 118 (84%) legs whilst the remaining 19 legs had an amputation performed after primary graft failure. Secondary reconstruction was successful in salvaging 63 limbs to mean follow-up, a 64% success rate from revisional surgery. At mean follow-up 339 of 395 limbs remain viable (86% limb salvage), secondary graft patency is 79% and primary graft patency 63%. Failure to re-intervene after primary graft failure would reduce limb salvage at 3 years to 70% with corresponding loss of 63 legs.(ABSTRACT TRUNCATED AT 250 WORDS)