Sequential aortofemoropopliteal/distal bypass for treatment of critical lower-limb ischaemia

Zukauskas, G; Ulevicius, H; Triponis, Vytautas

doi:10.1016/0967-2109(96)82868-7

Cited by 7 publications

(2 citation statements)

References 19 publications

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“…All patients within this cohort had runoff disease, and many had aortic segment disease. Primary outflow bypass patency rates after skip grafting were between 84.9% and 91.4% at 1 year, depending on whether reconstruction was staged in series of Zukauskas et al 5 Our reintervention rate is high, but outcomes in terms of secondary patency at 1 year (82.5%, 95% CI, 64%-100%) justify the effort put into these grafts. These are comparable to secondary patency of 86.1% to 92.2% reported by Zukauskas et al 5 This is reflected in limb survival statistics at 1 (88%, 95% CI, 72%-100%) and 4 years (73%, 95% CI, 44%-100%).…”

Section: Discussionmentioning

confidence: 72%

“…They report 1 amputation and 2 graft occlusions after undertaking iliac stenting and distal bypass in 12 limbs for iliofemoral occlusive disease. 5 Primary patency and mortality are disappointing after ilio-popliteal grafting. At the moment, multilevel or skip grafting remains the gold standard procedure, and data regarding endo-luminal or hybrid procedures are not yet mature enough to judge their role in managing complicated disease patterns.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of Ilio-Popliteal Grafting for Peripheral Arterial Disease

et al. 2009

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Outcome of Ilio-Popliteal Grafting for Peripheral Arterial Disease

et al. 2009

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Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia

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Bradbury

Kolh³

et al. 2019

European Journal of Vascular and Endovascular Surgery

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530

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Global vascular guidelines on the management of chronic limb-threatening ischemia

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Bradbury

Kolh³

et al. 2019

Journal of Vascular Surgery

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865

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Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.

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Sequential aortofemoropopliteal/distal bypass for treatment of critical lower-limb ischaemia

Cited by 7 publications

References 19 publications

Outcome of Ilio-Popliteal Grafting for Peripheral Arterial Disease

Outcome of Ilio-Popliteal Grafting for Peripheral Arterial Disease

Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia

Global vascular guidelines on the management of chronic limb-threatening ischemia

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