Result of supra-genicular femoropoliteal bypass done for critical limb ischemia

الملخص EN

-Objective: To report our experience with supra-genicular femoropopliteal bypass performed for critical limb ischemia.

Methods: This is a retrospective review of supra-genicular femoropopliteal bypass were performed at our vascular surgery unit in King Hussein Medical Center, Amman, Jordan, between March 2008 and March 2010.

Sixty three patients (49 male, 14 female) had 67 procedures (bilateral in 4 patients).

Fifty seven procedures done in 53 patients for critical limb ischemia were followed up for twelve months.

During this period eight patients were lost to follow-up and were also excluded from the analysis.

Records of the remaining 45 patients (35 male, 10 female) with 49 procedures were analyzed for operative details, patient risk factors, primary patency rates, complications, limb salvage rates.

The surgical technique was uniform.

Follow-up was clinical and by duplex scanning at six weeks, three and six months, and one year.

Graft patency was considered terminated if the patient had an occluded graft or needed further procedures to keep the graft patent.

Results: In 31 (63.3%) limbs the indication for the procedure was tissue loss, while in 18 (36.7%) it was rest pain.

The primary end point was primary graft patency calculated as 69.4% (reversed long saphenous vein 83.3%, prosthetic 61.3%).

The limb salvage rate was 83.7% (reversed long saphenous vein 88.9%, prosthetic 80.6%).

Five major limb amputations were done for non-healing wounds and three for prosthetic graft infections.

Procedure related complications included surgical wound problems,(5) and nerve injuries.(4) The most ominous complication was prosthetic graft infection as three out of four resulted in graft occlusion and removal and eventual limb loss while one was replaced by saphenous vein.

Perioperative 30 day mortality was two (3.8%) patients while another six (11.3%) died during the one year follow up period.

Conclusion: Supra-genicular femoropopliteal bypass performed for critical ischemia has an acceptable patency rate at one year and is an effective mean of limb salvage.

Prosthetic graft infections are a main cause of limb loss.

The use of vein conduits should be aggressively pursued.