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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 1998 June;39(3):267-72

lingua: Inglese

Are femo­ro-infra­pop­li­teal bypass­es worth­while for ­limb sal­vage?

Cavil­lon A., Mel­liere D., Allaire E., Espe­jel Blan­cas A., Ber­rahal D., Des­grang­es P., Bec­que­min J. P.

From the Department of Vascular Surgery Val de Marne University, Paris, France


Objective. This ­study was per­formed in ­order to deter­mine if: 1— femo­ral bypass­es end­ing ­below the pop­li­teal ­artery are jus­ti­fied in ­aged ­patients or in ­patients ­with ­poor gen­er­al con­di­tions, 2— if the use of pros­thet­ic mate­ri­al is jus­ti­fied ­when no ­vein is avail­able, 3—- if re-inter­ven­tion is ben­e­fi­cial in ­case of ­bypass occlu­sion.
Experimental ­design. Retrospective ­study of 162 infra­pop­li­teal bypass­es fol­lowed dur­ing 1 to 12 ­years (­mean: 1.5).
Setting. Vascular Surgery Department of the University Hospital Henri Mondor ­based in a sub­urb of Paris, France.
Patients. All ­patients who under­went a femo­ral ­bypass end­ing ­below the pop­li­teal ­artery for ­limb sal­vage ­from January 1984 to December 1995.
Intervention. These bypass­es ­were per­formed ­with a ­vein in 131 cas­es and ­with a ­PTFE ­graft (­with or with­out dis­tal cuff) in 31 cas­es.
Measures. All ­patients ­were fol­lowed ­with clin­i­cal eval­u­a­tion and duplex scan. Primary and sec­on­dary paten­cy, ­limb sal­vage and ­patient sur­vi­val ­were stud­ied. The sur­vi­val ­rates at 1 and 5 ­years ­were 87±3.8% and 66±9.6% respec­tive­ly. Preoperative mor­tal­ity was 7.4%. Renal insuf­fi­cien­cy requir­ing dial­y­sis, not age ­over 80, was asso­ciat­ed ­with ­high per­i­op­er­a­tive mor­tal­ity.
Results. The pri­mary paten­cy ­rates of the ­total ­series at 1 and 5 ­years ­were 55 and 35% respec­tive­ly for the ­total ­series. For ­venous bypass­es, it was 58 and 37% ­while for pros­thet­ic bypass­es, it was 49 and 15%. The sec­on­dary paten­cy ­rates at 1 and 5 ­years ­were 67 and 46% for the ­total ­series. For ­venous bypass­es, it was 70 and 49% and for pros­thet­ic bypass­es, it was 53 and 21%. Limb sal­vage ­rates at 1 and 5 ­years ­were 65 and 61% for the ­total ­series, 73 and 65% for ­venous bypass­es and 48 and 41% for pros­thet­ic bypass­es.
Conclusion. 1— Femor­o­ti­bi­al or per­oneal bypass­es are worth­while for ­limb sal­vage ­even in ­aged ­patients but ­renal insuf­fi­cien­cy requir­ing dial­y­sis may jus­ti­fy pri­mary ampu­ta­tion. 2— If no ­vein can be ­used, pros­thet­ic or com­pos­ite bypass­es ­should be per­formed ­because ­they are asso­ciat­ed ­with a 41% ­limb sal­vage ­rate at 5 ­years. 3— If throm­bo­sis ­occurs, the ­increase of paten­cy ­after re-op­er­a­tion is 12% in ­case of ­venous ­bypass and 6% in ­case of pros­thet­ic ­bypass.

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