The benefits of secondary interventions in patients with failing or failed pedal bypass grafts

Background: Autogenous bypass grafts to pedal arteries have successfully salvaged limbs and restored function in patients with critical ischemia. The benefits of secondary interventions to save failing or already failed grafts remains uncertain. Methods: A retrospective analysis was made of consecut...

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Bibliographic Details
Published in:The American journal of surgery 1999-08, Vol.178 (2), p.151-155
Main Authors: Rhodes, Jeffrey M, Gloviczki, Peter, Bower, Thomas C, Panneton, Jean M, Canton, Linda G, Toomey, Barbara J
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Amputation
Angioplasty
Angioplasty, Balloon
Anticoagulants
Arteries
Arteries - surgery
Balloon treatment
Biological and medical sciences
Bypass
Cardiovascular disease
Cardiovascular system
Creatinine
Diabetes
Diabetes Complications
Diabetes mellitus
Dialysis
Failure
Female
Follow-Up Studies
Foot - blood supply
Foot - surgery
Foot Ulcer - complications
Gangrene
Graft Survival
Grafting
Grafts
Humans
Intervention
Ischemia
Ischemia - surgery
Kidneys
Life Tables
Limbs
Male
Medical sciences
Middle Aged
Patients
Rank tests
Renal insufficiency
Renal Insufficiency - complications
Retreatment
Retrospective Studies
Revisions
Risk factors
Saphenous Vein - transplantation
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surveillance
Thrombectomy
Thrombolysis
Thrombolytic Therapy
Thrombosis
Treatment Outcome
Ultrasonic imaging
Vascular Patency
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
Veins
Veins - transplantation
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Summary:Background: Autogenous bypass grafts to pedal arteries have successfully salvaged limbs and restored function in patients with critical ischemia. The benefits of secondary interventions to save failing or already failed grafts remains uncertain. Methods: A retrospective analysis was made of consecutive pedal bypasses performed between 1987 and 1998. Patency and limb salvage by life-table analysis and variables affecting outcome were compared with the log-rank test. Results: Two hundred thirteen patients, 144 males, 69 females (mean age 68 years, range 30 to 91) underwent pedal bypass grafting in 228 limbs using autogenous vein grafts (nonreversed saphenous vein, n = 190; reversed, n = 15; composite, n = 23). One-hundred fifty-seven patients were diabetic, 34 had renal insufficiency (serum creatinine >2.0), and 14 were on dialysis. Gangrene or ulceration were present in 224 patients, rest pain in 24. Cumulative primary and secondary patency rates were 57% and 67% at 5 years. Limb salvage was 78% at 5 years. Secondary interventions in 46 patients included patch angioplasty/surgical revision (n = 28), thrombectomy (n = 15), thrombolysis (n = 11), and balloon angioplasty (n = 6). Patency in 19 of 26 (73%) failed grafts and in 19 of 20 (95%) failing grafts could be restored initially. Cumulative 2-year patency and limb salvage rates following reinterventions were 36% and 58%, respectively. Patency rates and limb salvage for failed grafts (7%, 44%) were significantly worse than those for failing grafts (81%, 77%; P
ISSN:0002-9610
1879-1883
DOI:10.1016/S0002-9610(99)00149-X