Examination of Difference in the Proximal Anastomotic Site for Crus, Ankle Bypass: Common Femoral Artery vs Below the Knee Popliteal Artery

Abstract

Objective: We evaluated the outcomes of bypass surgery for revascularization in cases of critical limb ischemia with the distal anastomotic site at or below the ankle; we focused on the differences in outcomes between 2 groups having different proximal anastomotic sites. Patients and Methods: Out of 270 cases diagnosed with critical limb ischemia from January 2003 to October 2009, bypass surgeries with the distal anastomotic site at or below the ankle were performed on the limbs of 69 patients (75 limbs). These cases were classified on the basis of the proximal anastomotic sites: group F (n = 50) where the common femoral artery was the proximal anastomotic site and group P (n = 25) where the below-knee popliteal artery was the site. Results:The 5-year cumulative primary/secondary patency rates were 69.3%/81.8% for group F and 68.7%/84.9% for group P. The 5-year cumulative limb salvage rate was 97.9% in group F and 80.3% in group P. Conclusion: Among the cases reviewed, results were comparable between cases with the proximal anastomotic site at the below-knee popliteal artery and those with the site at the common femoral artery.

Outcomes of Popliteal-To-Distal Bypass Combined with Femoropopliteal Artery Endovascular Treatment for Critical Limb Ischemia

“…1 ) Since this report, many investigations have supported the preferential use of the SFA and the PA as inflow sites of distal vein bypass for patients with a palpable popliteal pulse. 2 – 16 ) Albers et al conducted a meta-analysis of 12,320 popliteal-to-distal bypasses. 15 ) The 5-year primary patency rate was 63.1%, secondary patency rate was 70.7%, and foot preservation rate was 77.7%, and they concluded that the popliteal-to-distal vein bypass is highly efficient in CLI treatment.…”

“…1 ) Clinical reports supporting the effectiveness and safety of this short distal bypass have appeared in succession, and the SFA and PA are now regarded as preferential inflow sites for distal bypass in select patients with a palpable popliteal pulse. 2 – 16 ) Although the popliteal-to-distal bypass has an unstable inflow, it has many merits, such as shortening the operating time, minimization of the surgical wound on the ischemic limb, and preservation of the saphenous vein.…”