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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2015 December;22(4):181-8
Below knee revascularization in the severe ischemic lower extremity: a comparison of long-term outcome of peroneal and tibial bypass
Battaglia G., Turiano S. A., Tringale R., Sabatino E., Monaca V.
Vascular and Endovascular Surgery Unit, Ferrarotto Hospital, Catania, Italy
AIM: The purpose of the study was to evaluate the reliability of the peroneal artery when used as a single target vessel in patients with critical ischemia or highly disabling claudicatio.
METHODS: From January 2004 to May 2015 in our Institution we performed 231 below knee revascularization procedures on a single distal vessel: 112 on the posterior tibial (TP), 80 anterior tibial (TA) and 39 on the peroneal artery (Pe). All patients were enrolled in the “Italian Propaten Registry”.The population includes 175 men and 56 women, mean age 72.1 aa; 219 were in critical ischemia and only one in highly chronic ischemia highly debilitating We used saphenous vein in 177 cases; in 54 cases we used the Propaten or a composite graft propaten / VGS for partial or total not avalaible vein graft. Access and surgical techniques are described.
RESULTS: The average surgical time was of 162 mm, with an average stay of 7.1 days post-operatively. We had 2 hospital death. There were 14 early thrombosis, 10 treated with embolectomy, 3 medical treatment and 1 with r-bypass. There is no statistically significant difference for the early thrombosis related target vessel or graft.
All patients are discharged, unless contraindicated, with dual antiplatelet therapy (aspirin 100 mg + 75 mg clopidogrel or dipyridamole 250 mg).
The mean follow-up was 30.2 months (1 to 117 months).
There were 71 more graft thrombosis, 36 patients were amputated and 7 underwent to a redo bypass graft. Twenty four patients died with patent bypass. The primary patency at 9 years was 62%,22% and 32% respectly TP, TA and Pe. Limb salvage 87.6% (TP), 75% (TA) AND 90% (Pe).
CONCLUSION: Results demonstrated how the peroneal artery is a good target vessel, for its ability to re-inhabiting the distal tracts of the tibialis vessel.