Tertiary Patency as a Measure of Active Revascularization Policy for Leg Salvage

Abstract

An active surgical strategy to save lower limbs of patients with critical leg ischemia includes not only infrainguinal bypass surgery but also repeated surgery when needed. A failed infrainguinal bypass often threatens viability of the patient's legs, at which point a redo bypass procedure with a new graft may be the only alternative to major amputation. We assessed tertiary patency, defined as the whole period of time with a patent infrainguinal graft in a leg, to illustrate future potential of limb salvage surgery after a failed bypass. A total of 593 patients with critical leg ischemia and tissue defects (Fontaine IV) who underwent infrainguinal bypass surgery between January 2000 and December 2005 at our institution were included in this retrospective study. Secondary and tertiary patency rates were 95 ± 1% and 96 ± 3% at 1 month, 75 ± 2% and 82 ± 2% at 1 year, and 61 ± 2% and 70 ± 3% at 5 years, respectively, p = 0.003. Leg salvage rate was 94 ± 1% at 1 month, 83 ± 2% at 1 year, and 78 ± 2% at 5 years. There was no significant difference between leg salvage and tertiary patency rates, p = 0.281. Tertiary patency rate was higher than the secondary patency rate. This result might reflect active limb salvage surgery with satisfactory results. The absence of a gap between tertiary patency and leg salvage rates indicates the importance of a patent infrainguinal bypass graft to save lower limbs of patients with ischemic tissue defects.