ULTRA DISTAL REVASCULARIZATION IN CRITICAL LIMB ISCHEMIA
THE FINAL FRONTIER
DOI:
https://doi.org/10.48750/acv.66Keywords:
Diabetic vascular complications, Diabetes mellitus, Critical limb ischemia, Vascular surgical proceduresAbstract
Introduction: Ultra distal conventional revascularization is still underused by the majority of vascular surgeons. Nevertheless, the few studies published on this subject show very promising results in terms of limb salvage and amputation free survival.
Objectives: The aim of this study is to evaluate the results of ultra distal conventional revascularization in patients with critical limb ischemia (stages 5 and 6 of Rutherford's classification). The technical details and surgical indications that influence results will also be analysed.
Material and methods: Retrospective study analysing all patients admitted to this institution with the diagnosis of critical limb ischemia in stages 5 and 6 of Rutherford's classification, that were submitted to ultra distal conventional revascularization. Our inclusion criterion was bypass surgery targeting the common plantar, internal plantar, external plantar or dorsalis pedis. Mortality, limb salvage, amputation free survival and graft patency were analysed by means of Kaplan-Meier product-limit method.
Results: Between April 2012 and March 2016, 50 ultra distal revascularization procedures, (35 targeting the dorsalis pedis artery, 10 to plantar arteries and 5 redo procedures for failing grafts) were performed in 41 patients (34 male and 7 female), with a mean age of 69.1 years. Autologous venous conduit was used in 84% of the procedures (n=42), with the remaining being composite bypasses of PTFE and vein (n=8). Mean follow-up was 20.8 months (2-47 months). There weren't any deaths within 30 days of surgery and mortality during follow up was 7.3% (n=3). There were 9 graft occlusions (2 early and 7 late) and 5 major amputations. Primary patency was 78% and primary assisted patency 82%. Limb salvage was accomplished in 88.9% of patients and amputation free survival was 66% at the end of follow-up.
Conclusions: Our results show that, in high volume dedicated centres, these procedures are very effective for limb salvage in patients with critical limb ischemia in stages 5 and 6 of Rutherford's classification. They should be taken in consideration in the absence of more proximal patent arteries or in patients already submitted to former revascularizations.
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