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Giornale Italiano di Chirurgia Vascolare 2000 June;7(2):105-13


language: English, Italian

Revascularization of the peroneal artery in chronic critical leg ischemia

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.

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