Infrapopliteal bypass for critical limb ischaemia. Early experience in the French West Indies.

From December 1992 to October 1995, 42 infrapopliteal arterial bypass operations for limb salvage were performed in 39 patients (including 22 diabetics) with critical limb ischaemia (mean age, 71 years). Thirty-four patients (87%) had tissue loss at admission (8 ulcers, 13 digit gangrenes and 13 extensive foot infections). Angiographic findings were consistent with atherosclerotic involvement of femoral and crural arteries. Outflow anastomotic sites were the popliteal (n = 5); tibial (n = 14); peroneal (n = 14) and pedal artery (n = 9). Autogenous saphenous vein was suitable in 27 procedures and inadequate in 15 (< 3 mm diameter, with gross fibrosis or segmental occlusion) requiring prosthetic or composite grafts. Postoperative mortality rate was 10%, related to concomitant cardiovascular diseases. Mean follow-up was 14 months (range, 3-35). Fourteen bypasses failed, 5 in the early period (8-30 days) and 9 within a mean interval of 7.6 months, resulting in 6 limb amputations. Overall life-table primary graft patency rates were 72% (+/- 8) at 12 months and 61% (+/- 9) at 2 years and were not significantly different in diabetic patients compared to those in non-diabetics. Primary graft patency rates were significantly lower in prosthetic or composite grafts compared to saphenous vein grafts (75% vs 32% at 2 years- p < 0.01), respectively. Overall life-table limb salvage rates were 84% (+/- 7) and 76% (+/- 9) at 12 and 24 months, respectively. Seventy-eight per cent of patients with limb salvage were relieved of ischaemic symptoms, 57% regained the ability to ambulate with improved functional level and 85% of tissue loss healed within a mean interval of 55 days. Infrapopliteal bypass operations for critical limb ischaemia performed in Martinique provide a fair chance of limb salvage despite limitations of medical facilities.