Abstract
Background: It has been shown that autogenous veins are associated with the best limb salvage rates for femorodistal bypass surgery. However, in emergency settings, when an autogenous vein is unavailable, use of synthetic graft material or amputation is a critical decision to make. Objective: To assess the appropriateness of femorodistal bypass grafts for acute limb ischemia in emergency settings. Methods: Patients who underwent emergent bypass and elective femorodistal bypass surgery between 1996 and 2006 were reviewed retrospectively in a single center. Results: There were 147 patients of which 84 had elective and 63 had emergent bypass. The graft patency rates for elective admissions were 44 and 25% vs. 25 and 23% for admissions for acute femorodistal graft surgery at 2 and 4 years, respectively (p < 0.004). Admissions for acute ischemia who were treated with prosthetic grafts had a primary patency of 24 vs. 27% for vein grafts at 2 years and 24 vs. 23% at 4 years (p = 0.33). In the acute femorodistal grafts group, primary patency at 2 years for vein and prosthetic grafts was 27 and 24% as compared to 42 and 32% for electives. These values for cumulative limb salvage rates for elective bypasses were 73 and 63% as compared to 52% at both time points in the acute femorodistal graft group (p < 0.004). In emergency settings, the limb salvage rate for acute femorodistal bypass with prosthetic grafts was 38%, and for vein grafts it was 62% at both time points (p = 0.08). Conclusion: The long term limb salvage rate of 38% suggests that emergent femorodistal revascularization is worthwhile.
Highlights
Kunlin used greater saphenous vein for the first time as bypass graft for superficial femoral artery in 1951.1Campbell et al introduced use of graft for femoral artery in 1979.2 The prevalence of infrainguinal bypass surgery has increased significantly since .[3]
The long term limb salvage rate of 38% suggests that emergent femorodistal revascularization is worthwhile
Many studies have demonstrated the advantages of utilizing vein grafts, long saphenous vein, over prosthetic grafts for lower extremity revascularization.[4,5,6,7]
Summary
Kunlin used greater saphenous vein for the first time as bypass graft for superficial femoral artery in 1951.1. Campbell et al introduced use of graft for femoral artery in 1979.2 The prevalence of infrainguinal bypass surgery has increased significantly since .[3] Many studies have demonstrated the advantages of utilizing vein grafts, long saphenous vein, over prosthetic grafts for lower extremity revascularization.[4,5,6,7] Many factors have been shown to affect the outcomes of infrageniculate bypass. 1. Norfolk and Norwich Vascular Unit, Norfolk and Norwich University Hospital, Norwich, United Kingdom. 2. School of Medicine, Health Policy & Practice, University of East Anglia, Norwich, United Kingdom. Femorodistal bypass grafts for acute limb ischemia - Khandanpour N et al. It has been shown that autogenous veins are associated with the best limb salvage rates for femorodistal bypass surgery. In emergency settings, when an autogenous vein is unavailable, use of synthetic graft material or amputation is a critical decision to make
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