WTP1.10 Infra-malleolar bypass in patients with chronic limb threatening ischaemia

Abstract

Abstract Introduction There is clinical equipoise surrounding the optimal strategy for revascularisation of infra-popliteal arterial disease. The BASIL-2 trial is attempting to address this. The trial has been designed to try and define whether a ‘vein bypass first’ or ‘best endovascular first’ strategy is superior. We have sought to explore the outcomes associated with ultra-distal bypass in a single Scottish Health Board. Methods This was a retrospective review of a single surgeon’s ultra-distal bypass practice over a 7 year period. Index cases were identified from a prospectively maintained logbook. Outcomes included were primary graft patency and amputation free survival. Results There were 22 procedures performed over the 7-year period of interest. Mean age of 66 years. 15/22 (68%) were diabetic. The dorsalis pedis was the most common arterial target (n=14). The primary graft patency at 3-years was 54%. During the follow-up period 50% of the patients had a major limb amputation. There was 1 death in the post-operative period prior to discharge. Discussion Primary patency and limb salvage at 3-years are acceptable, although they are less than that described in the contemporary literature. It is likely that this may a consequence of selection bias given the local prejudice for an endovascular ‘first strategy’.