Clinical results of autologous infrainguinal revascularization using grafts originating distal to the femoral bifurcation in patients with mild inflow disease.

Détails

ID Serval
serval:BIB_BCDAC7973E06
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Clinical results of autologous infrainguinal revascularization using grafts originating distal to the femoral bifurcation in patients with mild inflow disease.
Périodique
Journal of Cardiovascular Surgery
Auteur(s)
Probst H., Saucy F., Dusmet M., Ris H.B., Ducrey N., Haller C., Corpataux J.M.
ISSN
0021-9509
Statut éditorial
Publié
Date de publication
2006
Peer-reviewed
Oui
Volume
47
Numéro
4
Pages
437-443
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article
Résumé
AIM: Chronic critical limb ischemia (CLI) often requires venous bypass grafting to distal arterial segments. However, graft patency is influenced by the length and quality of the graft and occasionally patients may have limited suitable veins. We investigated short distal bypass grafting from the superficial femoral or popliteal artery to the infrapopliteal, ankle or foot arteries, despite angiographic alterations of inflow vessels, providing that invasive pressure measurement at the site of the planned proximal anastomosis revealed an inflow-brachial pressure difference of <or=10 mmHg. METHODS: Four hundred and twenty-three consecutive infrainguinal bypass grafts were performed for CLI between June, 1999 and November, 2002 at our institution. All patients underwent preoperative clinical examination, arteriography and assessment of the veins by duplex ultrasound. The study group are patients in whom the proximal and distal anastomoses of the bypass are below the femoral bifurcation and the popliteal artery, respectively. Invasive arterial pressure measurements were recorded at the level of the planned proximal anastomosis which was performed at that level if the difference of the inflow-brachial pressure was <or=10 mmHg, irrespective of angiographic alterations of the inflow vessels proximal to the planned anastomosis. All patients had a clinical follow-up included a duplex examination of their graft, at 1 week, 3, 9 and 12 months and, thereafter, annually. No patient was lost to follow-up. RESULTS: Sixty-seven patients underwent 71 short distal bypass grafts in 71 limbs with reversed saphenous vein grafts in 52, in situ saphenous veins in 11, reversed cephalic vein in 1 and composite veins in 7, respectively. Surgical or endovascular interventions to improve inflow were required in 4 limbs (5.6%). The mean follow-up time was 22.5 months and the two-year survival was 92.5%. Primary and secondary patency rates at 2 years were 73% and 93%, respectively, and the limb salvage rate was 98.5%. CONCLUSION: In appropriately selected patients, short distal venous bypass grafts can be performed with satisfactory patency and limb salvage rates even in the presence of morphologic alterations of the inflow vessels providing that these are not hemodynamically significant, or can be corrected intraoperatively.
Mots-clé
Aged, Aged, 80 and over, Angiography, Digital Subtraction, Blood Vessel Prosthesis Implantation, Female, Femoral Artery, Humans, Incidence, Ischemia, Leg, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Saphenous Vein, Severity of Illness Index, Survival Rate, Transplantation, Autologous, Treatment Outcome, Ultrasonography, Doppler, Duplex
Pubmed
Web of science
Création de la notice
29/01/2008 14:00
Dernière modification de la notice
03/03/2018 20:57
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