Abstract
Objectives: Assessments of outcome after reconstruction for critical limb ischemia frequently ignore functional result and long-term morbidity and mortality. This study was undertaken to identify factors affecting long-term clinical outcome and survival after pedal bypass grafting. Methods: The clinical data of 256 consecutive patients who underwent pedal bypass grafting for critical limb ischemia over a 12-year period were retrospectively analyzed. Results: A total of 174 men and 82 women (median age, 70 years; range, 30-91 years) underwent 280 pedal bypass graft placements with autologous vein. Seventy-five percent of the patients were diabetic, and 20% had renal insufficiency (serum creatinine level > 2 mg/dL). The in-hospital mortality rate was 1.6% (4/256). The mean follow-up was 2.7 years (range, 0.1-10.1 years). Rates of primary and secondary patency, limb salvage, and survival at 5 years were 58%, 71%, 78%, 60%, respectively. A total of 160 limbs (57%) required additional interventions. Nineteen early graft thrombectomies/revisions and nine early amputations were performed. One hundred thirty-eight late interventions included 31 graft salvage procedures, 27 wound debridements, and 34 minor and 42 major amputations. At last follow-up or death, 219 (78%) limbs were being used for ambulation. End-stage renal disease (ESRD) and composite vein grafts predicted limb loss (P <.001, P <.001, respectively). Overall survival at 5 years was 60%. Survival after amputation was 79%, 53%, and 26% at 1, 3, and 5 years. Amputation and ESRD predicted higher mortality (P =.014, P =.0001, respectively). Conclusions: Pedal bypass grafting resulted in good functional limb salvage, but at the expense of multiple interventions in more than half the cases. ESRD and composite vein graft were associated with poor long-term limb salvage. Amputation after bypass grafting was associated with significantly worse long-term survival. (J Vasc Surg 2001;33:6-16.)
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
