Jorgensen MMT*, Jepsen JM, Rai A, Hallenbert C and Houlind KC
Department of Vascular Surgery, Kolding Hospital, DenmarkFulltext PDF
Background: Bypass surgery below the ankle is now rarely used as prevention of major amputations due to critical limb ischemia. We aimed to investigate results after bypass surgery below the ankle performed at a single center in Denmark. The study was designed as a retrospective, single centre study and endpoints were major amputations, overall survival as well as amputation-free and intervention-free survival. Methods: We included all patients undergoing pedal bypass surgery at a single vascular centre in Denmark. Baseline was set as date of surgery and patients were followed until amputation, death or end of study. The mean amputation-free and overall survival as well as primary and secondary patency was calculated using Kaplan Meier survival analysis. Cox regression analysis was performed to investigate possible significant co-variables. Results: We included 93 patients with 99 bypasses. 16 patients (16.5%) experienced one or more open and/or endovascular bypass revisions and 26 (28%) experienced major amputation. Mean patency, primary as well as secondary, was 2.6 years. Mean amputation-free survival was 2.9 years and mean overall survival 3.9 years. Conclusion: This study shows that in many cases bypass surgery to a pedal artery can prevent major amputation in patients with critical limb ischemia and that patients undergoing this kind of surgery have an expected amputation-free survival comparable to patients undergoing crural bypass operations above the ankle reported in earlier studies. Therefore, this type of operation should be considered as treatment to prevent amputation in patients with no graftable arteries on the lower leg above the ankle.
Jorgensen MMT, Jepsen JM, Rai A, Hallenbert C, Houlind KC. Pedal Bypass Surgery Prevents Amputation in Patients with Critical Lower Limb Ischemia - A Single Center Experience of 99 Pedal Bypass Operations. Clin Surg. 2020; 5: 2915..