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Online ISSN 1827-1847
Palumbo N., Cevolani M., Paragona O., Tedesco A., Leone M.
From the Department of Surgical and Anesthesiological Sciences Vascular Surgery Section Policlinico S. Orsola University of Bologna, Bologna, Italy
Background and aim. The aim of this study was to evaluate the factors determining the success of femoroperoneal bypass in patients with chronic critical leg ischemia.
Methods. The evolution of 82 femoroperoneal bypasses performed consecutively from January 1991 to December 1996 was studied retrospectively in 82 patients suffering obliterating arterial disease of the lower limbs with chronic critical ischemia. The mean age of patients was 69 years (47-88); 61 patients were male (74%). Thirty-two patients (39%) were diabetic. Indications for surgery were rest pain in 39 patients (47%), non-cicatrising ischemic ulcer in 33 patients (40%) and gangrene of the toes in 10 patients (13%). The mean systolic ankle-arm pressure index (AAI) was 0.4 (±14) before surgery. The autologous saphenous vein was used 65 times (79%) and a polytetrafluoroethylene (PTFE) graft was used 17 times (21%). Fifty bypasses (61%) were carried out in the proximal half of the peroneal artery and 32 (39%) in the distal half. The mean follow-up was 26 months (1-72). Only one patient abandoned the study. The results were evaluated using the actuarial method.
Results. Three patients (3.6%) died during the postoperative period. Fifteen patients died during the study. The five-year actuarial survival rate was 63% (±9). The primary patency rate was 84% (±3) at one month, 63% (±5) at one year, 60% (±6) at 3 years and 55% (±15) at 5 years. Thirty bypasses became thrombotic during the study, of which eleven were treated, obtaining secondary patency of 89% (±3) at one month, 79% (±4) at one year, 73% (±3) at 3 years and 65% (±7) at five years. Fifteen patients (18%) underwent major amputation, of whom 8 (10%) during the postoperative period and 7 during the study. The limb salvage rate was 90% (±3) at one month, 85% (±4) at one year, 81% (±4) at three years and 78% (±5) at five years. Of all the parameters examined, the material used for bypass (p=0.03), vein diameter and vein quality were predictive of the patency of the femoroperoneal bypass (p=0.0003).
Conclusions. These results are comparable to those for femorotibial bypass reported in the literature and should therefore encourage the use of femoroperoneal bypass in all patients with chronic critical leg ischemia, preferably using autologous venous graft when it is available and good quality.
language: English, Italian