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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2001 March;8(1):25-32
language: English, Italian
Results of distal revascularisation. Follow-up of 50 cases
Tassinari L., Carmo M., Mingazzini P., De Angelis G. A. T., Settembrini P. G. *
From the Division of Vascular Surgery “S. Carlo Borromeo” Hospital, Milan
* 2nd Department of Vascular Surgery University of Milan
Background. The aim of this study was to evaluate the results of distal revascularisation, and in particular to analyse the impact of various risk factors (diabetes mellitus, chronic renal insufficiency, absence of vein graft, trophic lesions) on the outcome.
Methods. A total of 50 femorodistal bypass operations were performed between June 1994 and June 1999. The indication for surgery was limb-threatening ischemia in 42 cases and severe claudication in 8 cases. The great saphenous vein was utilised in 30 patients, composite grafts in 14 and synthetic grafts alone in 6. The average follow-up of these patients was 16 months (range: 1-54). Bypass patency was assessed using c.w. Doppler scan. In cases where the Doppler was not clear-cut, an angiography was performed. Global primary and secondary patency rates were calculated. The authors compared the one-year secondary patency rates among the following risk classes: 3rd vs 4th stage, diabetes vs non-diabetics, diabetics without vein graft vs diabetics with vein graft, diabetics at 3rd stage vs diabetics at 4th stage, chronic renal insufficiency vs non-chronic renal insufficiency, diabetics at 4th stage without vein graft vs other diabetics.
Results. Limb salvage was achieved in 35 cases (70%). The one-month, one-year and 3-year primary and secondary patency rates were respectively 74% and 82%, 59% and 72%, 54% and 72%. None of the comparisons between the risk classes was statistically significant. Diabetics at 4th stage without vein graft had the worst outcomes.
Conclusions. Primary amputation appears to be justified only in severe and well-selected cases.