Pedal Bypass –⁠ Ten Years Experience

Czech version

Authors: R. Staffa; Z. Kříž
Authors‘ workplace: II. chirurgická klinika LF MU a FN u sv. Anny v Brně, přednosta: prof. MUDr. R. Staffa, Ph. D.
Published in: Rozhl. Chir., 2010, roč. 89, č. 1, s. 55-58.
Category: Monothematic special - Original

Overview

The authors evaluate a group of 110 patients to whom a pedal bypass was implanted in the period from October 2000 to July 2009. In all cases the limb was at risk of high amputation and the possibilities of endovascular and conservative therapy were exhausted. No patient died during the procedure, early postoperative mortality was 1.8%. During the follow-up (average, 30 ± 26.4 months; range, 1.2–91.2 months) 21 bypass occlusions occurred, of which in 8 cases bypass patency was restored by an early intervention. In the reference period the cumulative probability of primary and secondary patency of pedal bypasses is 67.2% and 69.5%, the cumulative probability of limb salvage by pedal bypass surgery is 78.0%. A part of the study is a statistical evaluation of the data and findings of how the primary and secondary patency of pedal bypasses and the probability of limb salvage are influenced by diabetes mellitus.

Key words:
pedal bypass –⁠ chronic critical lower limb ischaemia –⁠ diabetic foot syndrome –⁠ long term outcomes

Sources

1. Rutherford, R. B., Baker, J. D., Ernst, C., Johnston, K. W., Porter, J. M., Ahn, S., et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J. Vasc. Surg., 1997; 26 : 517–538.

2. LoGerfo, F. W., Coffman, J. D. Vascular and microvascular disease of the foot in diabetes: implication for foot care. N. Eng. J. Med., 1984; 311 : 1615–1619.

3. Staffa, R., Gregor, Z., Wasikova, S. Urgent pedal bypass grafting for salvage of a critically ischaemic limb with a trombosed popliteal aneurysm. Acta Chir. Belg., 2007; 107 : 416–418.

4. Spáčil, J., Táborský, J. Klesá počet amputací dolních končetin? Rozhl Chir 2008; 87(10): 531–535.

5. LEA Study Group. Comparing the incidence of lower extremity amputations across the world: the global lower limb amputation study. Diabet. Med., 1995; 12 : 14–18.

6. Kožnar, B., Peregrin, J. H. Factors influencing clinical result of the infrapopliteal arteries PTA. CEVJ, 2008; 7 : 16.

7. Staffa, R., Vlachovský, R., Vojtíšek, B. Follow-up and its importace for long term pedal bypass functionality. Acta Chir. Belg., 2006; 106 : 81–85.

8. Connors, J. P., Walsh, D. B., Nelson, P. R., Powell, R. J., Fillinger, M. F., Zwolak, R. M., et al. Pedal branch artery bypass: a viable limb salvage option. J. Vasc. Surg., 2000; 32 : 1071–1079.

9. Kalra, M., Gloviczki, P., Bower, T. C., Panneton, J. M., Harmsen, W. S., Jenkins, G. D., et al. Limb salvage after successful pedal bypass grafting is associated with improved long-term survival. J. Vasc. Surg., 2001; 33 : 6–16.

10. Pomposelli, F. B., Kansal, N., Haman, A. D., Belfield, A., Sheahan, M., Campbell, D. R., et al. A decade of experience with dorsalis pedis artery bypass: Analysis of outcome in more than 1000 cases. J. Vasc .Surg., 2003; 37 : 307–315.

11. Staffa, R., Kříž, Z., Gregor, Z., Vlachovský, R., Vojtíšek, B., Hofírek, I. Pedal bypass grafting on arteriographically invisible foot arteries detected by duplex ultrasound for limb salvage. Minerva Chir., 2007; 62(2): 115–124.

12. Panneton, J. M., Gloviczki, P., Bower, T. C., Rhodes, J. M., Canton, L. G., Boomey, B. J. Pedal bypass for limb salvage: impact of diabetes on-long term outcome. Ann. Vasc. Surg., 2000; 14 : 640–647.