We presented our results for bypass procedures to the foot arteries below the ankle at the 2009 meeting of the Vascular Society in Liverpool in 2009.
Popliteo–pedal bypass surgery for critical limb ischemia - a single centre 10 year experience
D Good, H Al Chalabi, F Hameed, F Cummins, B Egan, S Tierney, TM Feeley. Vascular Surgical Unit, Adelaide & Meath Hospital, Tallaght, Dublin 24.
Objective: Endovascular revascularisation may have a role in patients with crural arterial disease but only the short term outcome is known. In fact, there is limited outcome data following open reconstruction for severe crural artery disease. We analysed indications for, and outcome from, pedal bypass procedures from July 1998 to November 2008.
Methods: Twenty eight bypass procedures in 24 patients of mean age 63.8 (range 37 to 92yrs) were performed. Risk factors included diabetes (n=19), coronary artery disease (n=11), dyslipidaemia (n=13), chronic renal impairment (n=9), hypertension (n=15) and smoking (n=14). Surgery was indicated for tissue loss (n=22) or rest pain (n=6). Autologous vein was used exclusively. The proximal anastomosis was to the below-knee popliteal artery in all patients; the distal anastomosis was to plantar (n=15) or dorsalis pedis (n=13). Ultrasound graft surveillance was performed every 6 to 12 months
Results: Using life table analysis, primary graft patency was 63.3% at 1, 3 and 5 years and secondary patency (3 reinterventions) was 74.6% at 1, 3 and 5 years. Amputation free survival was 81.8% after 1, 3 and 5 years as all 5 limb amputations were performed in the first 3 months following surgery. Overall survival was 75%, 75% and 47.1% at 1, 3 and 5 years respectively.
Conclusion: Our data indicates that popliteopedal bypass is an effective treatment for distal vascular disease in those with severe comorbidity and limited life expectancy. The results of surgery provide a yardstick against which the outcomes of endovascular technology should be measured.
