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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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