Results of infrainguinal bypass surgery: an analysis of 263 consecutive operations.

BACKGROUND AND AIMS: The purpose of this clinical study was to assess the success of infrainguinal revascularization in the treatment of lower limb ischaemia. MATERIAL AND METHODS: 226 consecutive patients underwent 263 femoropopliteal (n = 194) or femorodistal (n = 69) bypass operations during 1988-1996 at a university hospital. Records of all patients were reviewed. Late control visits including clinical and colour doppler ultrasound examinations were programmed for 109 patients. Initial success, primary and secondary patencies, limb salvage and survival rates were determined and factors affecting outcome were analysed in various patient categories. RESULTS: Initial success rate was 92% (243/263). The primary and secondary patencies were 70/83% and 52/63% at one and five years, respectively. The corresponding limb salvage rates for patients with chronic critical ischaemia were 82% and 77%. The number of diseased vessels in the treated limb correlated negatively with the primary patency. Advanced age did not affect primary patency or limb salvage rates. Diabetes and the use of distal revascularizations were independent predictors of poorer limb salvage. Diabetes and renal insufficiency proved to shorten life expectancy. CONCLUSIONS: Infrainguinal revascularizations are effective regardless of patient's age. The extent of atherosclerotic changes in the operated limb, diabetes and renal insufficiency are factors affecting outcome.

Axillofemoral bypass operations in Kuopio University Hospital 1985-1996.

BACKGROUND AND AIMS: Axillofemoral bypass has been used since the 1960's in poor-risk patients with aortoiliac atherosclerotic occlusive disease to improve arterial circulation in the lower extremities. This article describes the outcome of 84 consecutive operations in our hospital. MATERIAL AND METHODS: During the period 1.1.1985-31.5.1996, 84 axillofemoral bypass operations were performed in our hospital. In this retrospective study, information was based on patient records and clinical follow-up examination for surviving patients living in the area of Kuopio province and operated before the end of 1995. Patencies and survivals were established using the life table method. RESULTS: The primary patency rate was 81.1 % at one year, 64.3 % at three years and 56.7 % at five years. The secondary patency rates were 92.1%, 67.1% and 57.7 %, respectively. The operative mortality rate was 6.0%. Eighty-five percent of the patients were alive one year after the operation, compared to 50 % after five years. Serious complications were rare, but local wound complications occurred in 29 %. Vascular reoperations were needed in 29 %, particularly thrombectomies. CONCLUSIONS: Axillofemoral bypass gives acceptable results in the treatment of lower leg ischaemia in elderly poor-risk patients.