OBJECTIVES: Compare the outcome of distal (bypass to the crural arteries) versus ultradistal (bypass to the pedal arteries) bypasses in patients with critical leg ischaemia (CLI). DESIGN: Retrospective analysis of prospectively collected data of patients with CLI undergoing infra-popliteal bypass surgery is performed. MATERIALS AND METHODS: Patients undergoing infra-popliteal bypass at a single institution between 2004 and 2010 are included. Patency rates at 1-year and amputation-free survival at 12 and 48 months are analysed. RESULTS: Two hundred and thirty bypasses were performed in 209 consecutive patients (156 men, median age; 76 years, range; 19-96 years). One hundred and seventy nine (78%) bypass were classified as distal and 51 (22%) as ultradistal. The incidence of diabetes mellitus was significantly higher in the ultradistal group (p=0.0025). At 1-year, the distal group primary, assisted-primary and secondary patency rates were 61.7%, 83.1% and 87.4% compared to 61.9%, 87.4% and 87.4% in the ultradistal group respectively. Amputation-free survival at 12 and 48 months was 82.9% and 61.5% in the distal group compared to 83.0% and 64.9% in the ultradistal group. CONCLUSIONS: This study show that both distal and ultradistal bypass have comparable outcome regardless of the co-morbidities. The authors believe that elderly patients should be offered ultradistal bypass if indicated to avoid major amputation.
OBJECTIVES: Compare the outcome of distal (bypass to the crural arteries) versus ultradistal (bypass to the pedal arteries) bypasses in patients with critical leg ischaemia (CLI). DESIGN: Retrospective analysis of prospectively collected data of patients with CLI undergoing infra-popliteal bypass surgery is performed. MATERIALS AND METHODS:Patients undergoing infra-popliteal bypass at a single institution between 2004 and 2010 are included. Patency rates at 1-year and amputation-free survival at 12 and 48 months are analysed. RESULTS: Two hundred and thirty bypasses were performed in 209 consecutive patients (156 men, median age; 76 years, range; 19-96 years). One hundred and seventy nine (78%) bypass were classified as distal and 51 (22%) as ultradistal. The incidence of diabetes mellitus was significantly higher in the ultradistal group (p=0.0025). At 1-year, the distal group primary, assisted-primary and secondary patency rates were 61.7%, 83.1% and 87.4% compared to 61.9%, 87.4% and 87.4% in the ultradistal group respectively. Amputation-free survival at 12 and 48 months was 82.9% and 61.5% in the distal group compared to 83.0% and 64.9% in the ultradistal group. CONCLUSIONS: This study show that both distal and ultradistal bypass have comparable outcome regardless of the co-morbidities. The authors believe that elderly patients should be offered ultradistal bypass if indicated to avoid major amputation.
Authors: Dean Y Huang; C Jason Wilkins; David R Evans; Thoraya Ammar; Colin Deane; Prashanth R Vas; Hisham Rashid; Paul S Sidhu; Michael E Edmonds Journal: Semin Intervent Radiol Date: 2014-12 Impact factor: 1.513
Authors: John S M Houghton; Sarah Nduwayo; Andrew T O Nickinson; Tanya J Payne; Sue Sterland; Mintu Nath; Laura J Gray; Greg S McMahon; Harjeet S Rayt; Sally J Singh; Thompson G Robinson; Simon P Conroy; Victoria J Haunton; Gerry P McCann; Matthew J Bown; Robert S M Davies; Rob D Sayers Journal: BMJ Open Date: 2019-09-03 Impact factor: 2.692