Clinical Significance of Venoplasties in Infragenicular Prosthetic Bypass Grafts

Overview

Aims:
Analysis of medium-term patency of prosthetic infragenicular bypass grafts with venoplasty of distal anastomosis and evaluation of venoplasties in patients with critical limb ischemia.

Study design:
A single centre, retrospective, non-randomised study.

Methods and Results:
In 1998–2005, 42 patients with critical limb ischemias were surgically managed at our clinic using infragenicular prosthetic bypass graft implantation with distal anastomosis venoplasty. 3 types of plasty were employed: Linton‘s, St. Mary’s boot and Taylor‘s plasty. Mean follow-up period was 25 months and primary functionality was 69%. Longterm functionality (over 5 years) was 35% and limb salvage rate was 38%. Functionality was assessed using life table analysis. 19% of patients exited during the follow-up period. In up to 30% patients, thrombolytic therapy was indicated for late bypass occlusion with a success rate of 63%.

Conclusion:
Prosthetic crural bypass is a relevant alternative to proximal level limb amputation. Venoplasty of distal anastomosis increases volume of the anastomosis and compensates for incongruencies of the graft and recipient vein lumen. Based on our experience, not a type of venoplasty, but a fact of increasing the anastomosis volume is most important. Whenever crural reconstructions are indicated, patient’s quality of life, expected survival period, degree of patient’s independence prior to surgery and patient’s compliance must be considered.

Key words:
critical limb ischemia – prosthetic bypass – venoplasty