Results of in-situ saphenous vein bypass to the foot

To determine the efficacy of extending vascular reconstruction to the pedal vessels, the records of 115 in-situ saphenous vein bypasses to the infragenicular vessels were examined. Ninety-four percent were performed for lim-threatening ischemia and 6 percent for claudication. Ninety-one bypasses were to tibial vessels in the calf (Group 1), whereas severe disease of the tibial vessels in the calf necessitated bypass to arteries at the ankle and beyond in 24 (Group 2). Life-table analysis was used to calculate limb salvage, graft patency, and functional status for Group 1 and Group 2 36 months postoperatively; there were no statistical differences between groups with regard to these variables (p = 0.38). Diabetes had no impact on the success of reconstruction, and preoperative noninvasive testing was not predictive of graft failure in either group. Significantly, limb salvage closely paralleled graft patency and functional status, illustrating the severe disease in all patients. Patients with severe tibial-peroneal atherosclerosis may benefit from bypass grafting to the pedal arteries with a success rate equal to those done to more proximal sites.
It is generally accepted that diseased arteries in the leg can be bypassed in order to reestablish blood supply and prevent loss of the leg due to ischemia (decreased blood supply). The ischemia is typically caused by atherosclerosis, cholesterol plaque formation on the lining of the artery wall. Controversy surrounds the methodology used to achieve the reconstruction of these arteries, in particular what route should be utilized to provide bypass of the blocked artery. One hundred fifteen lower leg vessel bypasses performed on 113 patients were studied. Group 1 consisted of 91 bypasses to the tibial vessels in the calf; group 2 consisted of 24 bypasses to the ankle or foot vessels located lower down the leg. Group 2 patients required bypass to the lower ankle and foot vessels because of severe disease in the vessels of the calf. The reason for the surgery was leg-threatening ischemia in 94 percent of patients, and claudication (weakness and cramps of the legs) in 6 percent. Three years later, the groups were compared in terms of leg salvage, graft patency (ability of the graft to remain open and allow the flow of blood), and functional status (ability to walk). There were no statistically significant differences between the groups on these factors. Diabetes was not found to influence the outcome of reconstructive surgery, and preoperative testing was not predictive of outcome. It is concluded that patients with severe ischemia of the lower leg may benefit from bypass to the vessels of the ankle and foot, with success rates similar to those of bypasses performed further up the leg. (Consumer Summary produced by Reliance Medical Information, Inc.)