Long-Term Results after Prosthetic Bypass Surgery for Chronic Limb Ischemia / 日本心臓血管外科学会雑誌

ABSTRACT

We evaluated long-term results of 126 consecutive bypass surgeries for chronic limb ischemia including 54 aorto-femoral (AF), 26 femoro-femoral crossover (FF), 7 axillo-femoral (AxF), and 39 femoro-above the knee popliteal (FP) bypasses. Patients who had undergone FF bypasses were significantly older than those who received AF bypasses (<i>p</i><0.01). Preoperative ankle brachial pressure indices (ABI) of the AxF and FF patients were significantly lower than those of AF patients (<i>p</i><0.05). Compared with AF patients, the AxF and FF groups included significantly higher percentages of Fontaine III and IV limbs treated by limb salvage surgery (<i>p</i><0.05). The cumulative graft patency rates 5 years after AF, FF, and FP bypasses were 94.7%, 91.3%, and 64.3%, respectively. In the FP group, patients with intermittent claudication before surgery showed a 5-year graft patency rate of 82.5%, while that in patients who underwent surgery for limb salvage was 43.3%. The secondary graft patency rates 5 years after AF, FF, and FP bypasses were 94.6%, 91.3%, and 83.3%, respectively. All patients whose bypass grafts were occluded were male and were smokers. Poor run-off and insufficient anticoagulation therapies were also associated with graft occlusion. Two of the 12 patients who developed graft occlusion underwent limb amputation.