Long-Term Results of Distal Bypass for Intermittent Claudication

Abstract

Background: Distal bypass (DB) is the optimal treatment for patients with critical limb ischemia (CLI). However, effectiveness of DB for patients with intermittent claudication (IC) remains uncertain. This study aimed to analyze long-term results of DB for IC patients (IC-DB) compared with those of DB for CLI patients (CLI-DB). Methods: Patients undergoing DB from January 2009 to July 2018 at a single institution were retrospectively reviewed. Operative details, primary and secondary patency, amputation free survival rate (AFS), and long-term exercise capacity using Barthel index were analyzed. Results: Out of 302 DB (245 patients), 49 IC-DB were performed in 43 patients: 38 males, mean age 70.3 ± 8.0 years, diabetes mellitus 51%, chronic renal failure with hemodialysis 7%. The Great saphenous vein was used in 47 limbs, the small saphenous vein in 1, and the arm vein in 1. These grafts were bypassed in a non-reversed fashion for 35 limbs, in an in-situ fashion in 9, and in a reversed fashion in 5. The mean operative time was 173 min. The mean follow-up was 25 ± 26 months. Primary and secondary patency of IC-DB was 79% and 94% at 1 year, 71% and 90% at 3 years, 65% and 90% at 5 years, which were significantly higher than those of CLI-DB (primary patency: P = .007, secondary patency: P = .025). AFS of IC-DB and CLI-DB was 100% and 77% at 1 year, 93% and 52% at 3 years, and 90% and 43% at 5 years (IC-DB vs. CLI-DB, p < .0001). Barthel index of IC-DB unchanged at discharge (median 100) and at the last visit (median 100), showing daily activity was maintained adequately. Conclusions: DB could offer a promising approach for patients with IC because of durable graft patency, acceptable AFS, and maintenance of daily activity.

Femorotibial Bypass Sutured on Bovine Pericardium Patch of the Femoral Artery for Bypass Inflow: A Case Report

“…Femorotibial bypass provides good blood flow to the lower limb and restenosis and reoperation are less frequent compared with endovascular treatment in the long term [4], although it is now widely applied for CLI because of its less invasiveness and shorter hospital stay. The reported five-year graft patency rate of the femoral-popliteal, tibial, and peroneal bypass with in situ GSV was 77%, and it is the procedure of choice for long infrapopliteal bypass [5]. In this case, femorotibial bypass with in situ vein graft was performed for the popliteal artery occlusion.…”

Distal Bypass Improves Skin Perfusion Pressure at the Whole Foot Regardless of Angiosomes in Patients with Chronic Limb-Threatening Ischemia

“…Successful bypass usually increases arterial pressure effectively and restores blood flow and collateral blood from beyond the areas of the angiosomes. 15) While primary patency of distal bypass at 1 year is 61%-79%, [16][17][18] the restenosis and occlusion rate of angioplasty for infrapopliteal lesions at 3 months is 73%. 19) These results indicate that elevated blood pressure with EVT decreases earlier than that after bypass and results in decreased blood flow in the tissue.…”