Repeat leg bypass after multiple prior bypass failures |
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| Affiliation: | 1. Postdoctoral Research Station of Crop Science, College of Agronomy, Shenyang Agricultural University, Shenyang 110866, China;2. Key Laboratory of Ecosystem Network Observation and Modeling, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China;3. Center for Excellence in Tibetan Plateau Earth Sciences, Chinese Academy of Sciences, Beijing 100101, China;4. College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100190, China;1. CHU de Brest, Service de Chirurgie cardiaque thoracique et Vasculaire, Brest, France;2. CHU de Rennes, Service de Chirurgie cardiaque thoracique et Vasculaire, Rennes, France;3. CHU Nantes, l’Institut du Thorax, Service de Chirurgie Vasculaire, Nantes, France;4. Université de Nantes, Nantes, France;5. INSERM, U957, Nantes, France;1. Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass;2. Division of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian, Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians & Surgeons, New York, NY;1. Department of Surgery, Amphia Hospital, Breda, The Netherlands;2. Department of Radiology, Amphia Hospital, Breda, The Netherlands |
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| Abstract: | Purpose: The optimal treatment of patients with severe lower extremity ischemia after multiple failed prior bypasses is unclear. It is presently unknown whether failure of attempted revascularization in these patients is so likely that such operation should not be elected. We have maintained an aggressive surgical policy of repeated revascularization regardless of prior failures. A review of our clinical experience with this difficult patient group was performed to determine the results of this policy.Methods: From 1980 to 1992, 85 revascularization procedures were performed in 81 patients with lower extremity ischemia after failure of two or more prior infrainguinal bypasses in the same leg. All patients were prospectively entered and monitored in our vascular registry. Seventy-two operations were the third procedure, six operations were the fourth procedure, and seven operations were the fifth procedure on the same extremity. Twenty-six of the 85 procedures (30%) were revisions of failing grafts discovered by routine surveillance methods, whereas 59 were replacements of thrombosed grafts. Autogenous reconstruction was used in 67 procedures (79%), and prosthetic reconstruction was used in 18 procedures (21%). The distal anastomosis was to the popliteal artery in 19 patients and infrapopliteal artery in 66.Results: Mean time to failure of the first leg bypass was 24 months and 4.9 months for the second bypass. Detailed hematologic screening revealed identifiable hypercoagulable disorders in nine (15%) of 59 patients screened after 1987. All nine had anticardiolipin antibodies. The operative mortality rate was 4%. Mean follow-up after the most recent operation was 17 months. The primary patency rate at 4 years was 79.8%. The limb salvage rate was 69.6% at 4 years.Conclusions: These results indicate that limb revascularization after two or more failed leg bypasses results in low operative mortality rates and surprisingly good primary patency and limb salvage rates at 4 years. The patient survival rate through 4 years is unexpectedly high. In our opinion these results justify an aggressive policy of limb revascularization after multiple failed prior bypasses. (J VASC SURG 1994;19:268-77.) |
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