Femoro-distal bypass surgery at Groote Schuur Hospital - 4-year retrospective study : vascular surgery

An analysis of the demographics and outcome of femoro-distal bypass in patients presenting with defined critical limb ischaemia at Groote Schuur Hospital; Cape Town; is presented. Materials and methods. A retrospective review was conducted between January 1998 and December 2001. During this period; 65 patients underwent femoro-distal bypass. Of these; 57 patients were analysed and 8 patients were excluded from the study because of incomplete medical records. Results. The median age of the patients in this study was 62 years; with a male-to-female ratio of 34:23. Twenty-eight patients (49) were diabetic. An overall 2- year mortality of 19.2was recorded. Reversed saphenous vein graft (RSVG) was used in 29 legs (50.9) and in situ vein graft (ISVG) in 19 legs (33.3). There was no statistically significant difference in the graft patency between the two methods (p = 0.39); the 2-year cumulative patency was 40for the RSVG and 39for the ISVG. In our unit only 2 factors influenced the outcome of femoro-distal bypass - local sepsis in the foot and an increased early postoperative ankle-brachial index (p 0.05). Diabetes mellitus; gender; age and race had no influence on the outcome. This study showed that the site of the distal anastomosis had no effect on graft patency or limb salvage. At 2 years; the cumulative patency and limb salvage rates were 40and 56respectively. Of the 11 grafts with stenotic lesions requiring intervention; 6 were detected between 18 and 24 months. Conclusion. Management of critical limb ischaemia is a major part of the workload in our unit; with most patients undergoing primary amputation. The surgical outcome of femoro-distal bypass was largely influenced by local sepsis and early postoperative ABI. We found that more than half the stenotic lesions detected during graft surveillance occurred beyond 18 months postoperatively. This suggests that a graft surveillance programme should continue beyond 18 months

Femoro-distal bypass surgery at Groote Schuur hospital--4-year retrospective study.

UNLABELLED: An analysis of the demographics and outcome of femoro-distal bypass in patients presenting with defined critical limb ischaemia at Groote Schuur Hospital, Cape Town, is presented. MATERIALS AND METHODS: A retrospective review was conducted between January 1998 and December 2001. During this period, 65 patients underwent femoro-distal bypass. Of these, 57 patients were analysed and 8 patients were excluded from the study because of incomplete medical records RESULTS: The median age of the patients in this study was 62 years, with a male-to-female ratio of 34:23. Twenty-eight patients (49%) were diabetic. An overall 2-year mortality of 19.2% was recorded. Reversed saphenous vein graft (RSVG) was used in 29 legs (50.9%) and in situ vein graft (ISVG) in 19 legs (33.3%). There was no statistically significant difference in the graft patency between the two methods (p = 0.39); the 2-year cumulative patency was 40% for the RSVG and 39% for the ISVG. In our unit only 2 factors influenced the outcome of femoro-distal bypass--local sepsis in the foot and an increased early postoperative ankle-brachial index (p < 0.05). Diabetes mellitus, gender, age and race had no influence on the outcome. This study showed that the site of the distal anastomosis had no effect on graft patency or limb salvage. At 2 years, the cumulative patency and limb salvage rates were 40% and 56% respectively. Of the 11 grafts with stenotic lesions requiring intervention, 6 were detected between 18 and 24 months. CONCLUSION: Management of critical limb ischaemia is a major part of the workload in our unit, with most patients undergoing primary amputation. The surgical outcome of femoro-distal bypass was largely influenced by local sepsis and early postoperative ABI. We found that more than half the stenotic lesions detected during graft surveillance occurred beyond 18 months postoperatively. This suggests that a graft surveillance programme should continue beyond 18 months.

Management of extra-cranial vertebral artery injuries.

OBJECTIVES: To review the management of vertebral artery injuries, and the impact of pre-operative angiography. MATERIALS AND METHODS: A retrospective review was conducted of all patients with vertebral artery (VA) injuries admitted to Groote Schuur Hospital, Cape Town between January 1987 and December 2002. Patients presenting with uncontrolled active bleeding or haemodynamic instability with a poor response to resuscitation were taken immediately to surgery. Stable patients, including those who stabilised after simple resuscitation, with evidence of a vascular injury (a bruit or a large haematoma) or trans-cervical gunshot wounds, underwent routine aortic arch and selective angiography. RESULTS: One hundred and one patients with vertebral artery injuries were included in the study. Ninety-two patients sustained penetrating injuries (41 gunshot, 51 stab), three were iatrogenic and six due to blunt trauma. Angiography was performed as the primary investigation in 88 patients, while seven patients had angiography following surgery. Thirty-nine vertebral artery occlusions, 11 arteriovenous fistulae, two intimal injuries and 36 false aneurysms were identified. Thirty-three radiological interventions were performed. There were 22 associated vascular injuries in 16 patients, 27 nerve injuries in 25 patients, 11 osseous injuries in nine patients and eight aerodigestive injuries. Seven patients died. CONCLUSIONS: Angiography and intervention is of great benefit in the diagnosis and management of traumatic vertebral artery injuries. Angiography often avoids unnecessary exploration and permits endovascular treatment.