Long-Term Results of Distal-Origin Bypass After Prior Femoro-Popliteal Angioplasty

Abstract

To investigate whether prior staged percutaneous transluminal angioplasty of the femoro-popliteal segment influences long-term results of distal bypass grafts. Between October 1987 and January 2009, 261 distal origin grafts for critical limb ischemia were performed at a single institution. A total of 223 grafts had angiographic no inflow lesions (-PA-group). Additionally, 38 grafts were performed staged within 30 days after percutaneous femoro-popliteal angioplasty (+PA-group) because of 28 TASC A (73%) and 10 TASC B (27%) lesions. Postoperative graft surveillance was performed at 3, 6, 12, and 18 months, then annually thereafter. Treatment groups were compared with Kaplan-Meier analysis. Follow-up ranged from 1 to 198 months (median, 34 months). The 5-year primary patency was 73% for the +PA-group and 62% for the -PA-group (p = 0.20). Assisted primary patency for the +PA-group at 5 years was 80% and for the -PA-group was 70% (p = 0.17). The corresponding secondary patency at 5 years was 84% for the +PA-group and 71% for the -PA-group (p = 0.12), respectively. Limb salvage and amputation free survival at 5 years were 84% and 46% for the +PA-group, and 81% and 37% for the -PA-group, respectively (p = 0.57, 0.92). Bypass-threatening stenosis of the inflow-vessel was detected for four (10.5%) cases in the +PA-group and for 21 (8%) in the -PA-group. Long-term results of distal origin grafts performed after femoro-popliteal angioplasty because of TASC A and B lesions are comparable with those observed in distal origin grafts without proximal stenosis. Distal origin bypass grafting is not compromised by prior endovascular treatment of the inflow-vessel.