Tibial and peroneal bypasses in octogenarians and nonoctogenarians with critical limb ischemia

Uhl, Christian; Hock, Carolin; Ayx, Isabelle; Zorger, N.; Steinbauer, Markus; Töpel, I.

doi:10.1016/j.jvs.2015.12.053

Cited by 11 publications

(4 citation statements)

References 19 publications

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“…Previous studies have demonstrated the benefit of bypass to the peroneal artery for pedal gangrene. [1][2][3] In patients with tissue loss (ulcer or gangrenous pedal lesions) and a peroneal artery as the only patent artery in the leg, choices for revascularization are limited to peroneal bypass. Whereas peroneal bypass requires less autogenous conduit than inframalleolar bypass, its efficacy depends on the patency of its branches.…”

mentioning

confidence: 99%

Impact of angiosome- and nonangiosome-targeted peroneal bypass on limb salvage and healing in patients with chronic limb-threatening ischemia

Ricco

Gargiulo

Stella

et al. 2017

Journal of Vascular Surgery

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confidence: 99%

Impact of angiosome- and nonangiosome-targeted peroneal bypass on limb salvage and healing in patients with chronic limb-threatening ischemia

Ricco

Gargiulo

Stella

et al. 2017

Journal of Vascular Surgery

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“…Their patency rates were similar when compared with controls 19 . Even in more complex below-the-knee revascularization procedures, outcomes of octo- and nonagenarians are satisfying with regard to patency rates and limb salvage 20 , 21 .…”

Section: Discussionmentioning

confidence: 99%

Alternative vein bypass in octogenarians with chronic limb-threatening ischaemia

Kluckner,

Enzmann,

Hitzl

et al. 2024

BJS Open

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Background Octogenarians are regarded as one of the frailest patient groups among the chronic limb-threatening ischaemia population with high perioperative morbidity and mortality rates. As a result, alternative vein bypass surgery in the absence of sufficient great saphenous vein is often not considered as a potential treatment option. The aim of this study was to compare the results of octogenarians undergoing alternative vein bypass surgery due to chronic limb-threatening ischaemia to younger patients. Methods A single-centre retrospective analysis of patients undergoing bypass surgery for chronic limb-threatening ischaemia with alternative autologous vein grafts between 1997 and 2018 was performed. Patients aged over 80 years were compared with those under 80 years. Graft patency rates were assessed and a risk factor analysis for limb loss was performed. Results In total, 592 patients underwent bypass surgery during the study interval. Twenty-one per cent (n = 126) of patients were 80 years or older. At 4 years, primary, primary-assisted and secondary patency as well as limb salvage rates were not significantly different between the two groups (46% versus 50%, 60% versus 66%, 69% versus 72%, 72% versus 77%, for octogenarians versus non-octogenarians respectively). Major amputations were performed in 27 (21%) octogenarians and 91 (20%) non-octogenarians (P = 0.190). No higher 30-day and long-term mortality rates nor morbidity rates were detected in the octogenarian group with a median follow-up time of 27 (interquartile range 12–56) months. Minor amputation, the reason for alternative vein grafts, as well as the profunda femoris artery as proximal origin of the bypass were risk factors for limb loss in the postoperative course. Conclusion Alternative vein bypass surgery in octogenarians with chronic limb-threatening ischaemia is safe and effective in terms of patency rates, limb salvage and survival compared with younger patients in the absence of sufficient great saphenous vein. Age alone should not be a deterrent from performing bypass surgery.

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“…In total, five of the 21 studies were considered to be of higher methodological quality (!7 points). Six studies investigated endovascular revascularisation only, 16,21,23,26,29,32 six studies investigated surgical revascularisation only, 17,20,27,28,31,34 and nine analysed both techniques. 10,15,18,19,22,24,25,30,33 In addition, in five studies a subgroup of patients was treated conservatively and four studies investigated outcomes after primary amputation as well.…”

Section: Study Characteristics and Patient Demographicsmentioning

confidence: 99%

Editor's Choice – Mortality and Major Amputation after Revascularisation in Octogenarians Versus Non-Octogenarians with Chronic Limb Threatening Ischaemia: A Systematic Review and Meta-Analysis

Wübbeke

Naves

Daemen

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS This systematic review and meta-analysis of more than 17 000 patients with chronic limb threatening ischaemia (CLTI) found an important one year mortality rate of 32% in octogenarians after revascularisation, which was significantly higher than in non-octogenarians. This outcome is of major importance to clinical practice to inform patients and colleagues adequately during the decision making process on any intervention in this fragile patient group. Objective: The aim of this systematic review and meta-analysis was to assess the clinical outcomes after revascularisation in octogenarians with chronic limb threatening ischaemia (CLTI). Methods: This was a systematic review and meta-analysis, in which the Medline, Embase, and Cochrane Library databases were searched systematically by two independent researchers. Meta-analyses were performed to analyse one year mortality, one year major amputation, and one year amputation free survival (AFS) after revascularisation. Pooled outcome estimates were reported as percentages and odds ratio (OR) with 95% confidence intervals (CI). In addition, sensitivity and subgroup analyses were performed and the quality of evidence was determined according to the GRADE system. Results: The review includes 21 observational studies with patients who were treated for CLTI. Meta-analysis of 12 studies with a total of 17 118 patients was performed. A mortality rate of 32% was found in octogenarians (95% CI 27e37%), which was significantly higher than in the non-octogenarians (17%, 95% CI 11e22%/OR 2.52, 95% CI 1.93e3.29; GRADE: "low"). No significant difference in amputation rate was found (octogenarians 15%, 95% CI 11e18%; non-octogenarians 12%, 95% CI 7e14%; GRADE: "very low"). AFS was significantly lower in the octogenarian group (OR 1.55, 95% CI 1.03e2.43; GRADE: "very low"). In a subgroup analysis differentiating between endovascular and surgical revascularisation, amputation rates were comparable. For octogenarians, those treated conservatively had a mortality rate significantly higher than those treated by revascularisation (OR 1.76, 95% CI 1.19e2.60; GRADE: "very low"). No significant difference in mortality rate was found between primary amputation and revascularisation in octogenarians (OR 0.70, 95% CI 0.24e2.03; GRADE: "very low"). Conclusion: In octogenarians with CLTI, a substantial one year mortality rate of 32% was found after revascularisation. The amputation rates were comparable between both age groups. However, only low quality evidence could be obtained supporting the results of this meta-analysis because only observational studies were available for inclusion.

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Tibial and peroneal bypasses in octogenarians and nonoctogenarians with critical limb ischemia

Abstract: Our analysis showed good results in octogenarians undergoing tibial and peroneal bypass surgery with regard to patency rates and limb salvage. However, octogenarians had a significantly higher perioperative mortality rate.

Cited by 11 publications

References 19 publications

Impact of angiosome- and nonangiosome-targeted peroneal bypass on limb salvage and healing in patients with chronic limb-threatening ischemia

Impact of angiosome- and nonangiosome-targeted peroneal bypass on limb salvage and healing in patients with chronic limb-threatening ischemia

Alternative vein bypass in octogenarians with chronic limb-threatening ischaemia

Editor's Choice – Mortality and Major Amputation after Revascularisation in Octogenarians Versus Non-Octogenarians with Chronic Limb Threatening Ischaemia: A Systematic Review and Meta-Analysis

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