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Bypass grafting for infrapopliteal occlusive disease with poor distal flow on angiography.

OBJECTIVE
We aimed to investigate whether limb-salvage bypass operation improves outcomes in patients with critical infrapopliteal ischemia and poor or no distal arterial flow on angiography.


METHODS
Forty-nine patients with severe tibial and peroneal occlusive disease and poor distal arterial flow on angiography were included in this prospective study. The age ranged from 57 to 82 years in the surgical group and 63 to 80 in the medical group. Patients had class III or IV disease according to Fontaine classification. Preoperative arterial Doppler ultrasonography and arteriography were performed in all patients. The ankle-brachial index (ABI) was calculated preoperatively and postoperatively in all of the cases. Twenty-three patients underwent distal bypass operation. Other 26 patients were followed with medical therapy. The outflow distal anastomoses were performed on posterior tibial, dorsal pedal, anterior tibial, peroneal, and lateral plantar arteries. All patients were followed-up for 3 years and clinical outcomes were recorded. The statistical analyses were performed using unpaired t, Mann Whitney and Wilcoxon tests.


RESULTS
There were 3 early and 2 late graft failures. Limb salvage rates were 84.2%, 84.2%, 73.7% in the surgical group, and 82.8%, 69.9%, 64.3% in the medical group respectively in 6 months, 1 year, and 3 years. According to statistical analysis; the levels of the amputations tend to be lower in the surgical group than in the medical group but it was not significant statistically. Surgical treatment reduced the amputation ratio (p<0.05) but medical therapy did not (p>0.05). The difference between preoperative mean ABI [0.26+/-0.06] and postoperative mean ABI [0.80+/-0.24] was significant (p<0.05).


CONCLUSION
We think that limb-salvage bypass operation may be preferred for patients with critical limb ischemia and poor distal flow on angiography. Infrapopliteal bypass will provide limb salvage and a functional extremity.