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- Title
Management of the Failed Primary Infrainguinal Reconstruction: Treatment Options and Long-Term Outcome.
- Authors
Akers Jr., Donald L.; Hewitt, Robert L.
- Abstract
Patients presenting with critical limb ischemia following failed infrainguinal grafts have been reported to have a significant amputation rate and reduced long-term survival. The authors reviewed their three-year experience with 33 patients with failed infrainguinal reconstruction. The median age was 63.1 years of age (range forty-three to eighty-seven years). There were 19 women and 14 men. Risk factors included the following: hypertension 31 (94%), diabetes 21 (64%), and tobacco use 30 (91%). All patients had limb-threatening ischemia, 15 had gangrene (45.4%), 8 had ulceration (24.2%), and 10 had rest pain 10 (30.3%). There had been 42 previous revascularizations (1.27 per patient, range 1 to 6). The authors performed 45 revascularization operations (1.36 per patient, range 1 to 4). Inflow was as follows; common femoral artery in 29 (64.4%), superficial femoral artery in 9 (20%), profunda femoris in 4 (8.9%), aortobifemoral graft limb in 2 (4.4%), and femoral-femoral bypass graft in 1 (2.2%). Outflow was as follows: posterior tibial artery 12 (26.7%), peroneal artery in 17 (37.8%), anterior tibial artery in 7 (15.6%), popliteal artery in 5 (11.1%), and tibioperoneal trunk in 4 (8.9%). The conduits were as follows: great saphenous vein (GSV) from the opposite lower limb in 8 (17.8%), GSV/lesser saphenous vein (LSV) composites in 8 (17.8%), expanded polytetrafluoroethylene in (ePTFE) 5 (11.1%), LSV composite in 10 (22.2%), ePTFE/GSV composite in 5 (11.1%), cadaveric vein in 2 (4.4%), superficial femoral vein/ePTFE composite in 2 (4.4%), endarterectomized superficial femoral artery/GSV composite in 1 (2.2%), GSV/upper limb vein composite in 1 (2.2%); and upper limb vein in 3 (6.7%). There was one perioperative death (2.2%). Six patients died during the follow-up period (74.1% survival). Limb salvage was obtained in 28 patients (83.1%). Cumulative secondary patency was 73.2% at three years. These results indicate that: (1) aggressive revascularization for failed...
- Subjects
DISEASES of the anatomical extremities; ISCHEMIA; PEDICLE flaps (Surgery); AMPUTATION; POLYTEF
- Publication
Vascular Surgery, 1996, Vol 30, Issue 4, p281
- ISSN
0042-2835
- Publication type
Article
- DOI
10.1177/153857449603000403