Popliteal-to-distal bypass for limb-threatening ischemia

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

Objective: The aim of this study was to evaluate outcomes of combined popliteal-to-distal bypass and endovascular treatment (EVT) for femoropopliteal lesions in patients with critical limb ischemia (CLI).

Patients and Methods: We reviewed data of 14 CLI patients who were treated by popliteal-to-distal bypass combined with femoropopliteal EVT. The femoropopliteal lesions included 3 TASC II-A, 8 TASC II-B, and 3TASC II-C but no TASC II-D, and balloon dilatation was performed in 9 cases and a stent was placed in 5 cases. The saphenous vein graft was used in all bypasses, and the target arteries were the dorsalis pedis artery in 12 cases and the posterior tibial artery in 2 cases.

Results: At 12 and 24 months, primary patency rates were both 79%, primary assisted and secondary patency rates were both 93%, limb salvage rates were both 93%, and survival rates were 92% and 84%, respectively. Restenosis after femoropopliteal EVT occurred in 2 cases, and both were successfully revised by additional endovascular balloon dilatation.

Conclusion: Combined popliteal-to-distal bypass and femoropopliteal EVT might be a useful therapeutic option for appropriately selected CLI patients. Intensive follow-up for endovascular treated lesions and vein graft is mandatory.

Endovascular therapy is effective treatment for focal stenoses in failing infrapopliteal vein grafts

BACKGROUND

To evaluate the efficacy of endovascular therapy for maintaining patency and preserving limbs among patients with failing infrapopliteal bypass grafts.

METHODS

We gathered data from a registry of catheter-based procedures for peripheral artery disease. Of 1554 arteriograms performed from 2006 to 2012, 30 patients had interventions for failing bypass vein grafts to infrapopliteal target vessels. The first intervention for each patient was used in this analysis. Duplex ultrasonography was used within 30 days after intervention and subsequently at 3- to 6-month intervals for graft surveillance.

RESULTS

Interventions were performed for duplex ultrasonography surveillance findings in 21 patients and for symptoms of persistent or recurrent critical limb ischemia in 9 patients. Procedural techniques included cutting balloon angioplasty (83%), conventional balloon angioplasty (7%), and stent placement (10%). Procedural success was achieved in all cases. There were no procedure-related complications, amputations, or deaths within 30 days. By Kaplan-Meier analysis, 37% of the patients were free from graft restenosis at 12 months and 31% were at 24 months. Receiver-operating characteristic analysis indicated that a lesion length of 1.75 cm best predicted freedom from restenosis (C statistic: 0.74). Residual stenosis (P = 0.03), patency without reintervention (P = 0.01), and assisted patency with secondary intervention (P = 0.02) rates were superior for short lesions compared with long lesions. The cohort had acceptable rates of adverse clinical outcomes, with 96% of patients free from amputation at both 12 and 24 months; clinical outcomes were also better in patients with short lesions.

CONCLUSIONS

In this single-center experience with endovascular therapies to treat failing infrapopliteal bypass grafts, rates of limb preservation were high, but the majority of patients developed graft restenosis within 12 months. Grafts with longer stenoses fared poorly by comparison. These data suggest that endovascular interventions to restore or prolong graft patency may be associated with maintained graft patency and that close follow-up with vascular laboratory surveillance is essential.

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

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.