Document Detail


Factors associated with limb loss despite a patent infrainguinal bypass graft.
MedLine Citation:
PMID:  9457035     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Lower-extremity limb salvage should parallel infrainguinal bypass graft patency. To determine factors associated with limb loss despite a patent bypass, we reviewed 191 consecutive infrainguinal bypasses in 158 patients followed prospectively over 42 months. In this series of 176 (92%) vein grafts, 15 (8%) expanded polytetrafluoroethylene grafts, 122 (64%) tibial artery bypasses, and 170 (89%) bypasses placed for limb salvage, 29 major lower-extremity (above-knee or below-knee) amputations were performed in 29 patients, 12 because of ischemia after graft thrombosis and 17 (9% of series) due to progression of soft tissue infection/necrosis despite a functioning bypass. Primary and secondary 36-month vein graft patencies by life-table analysis were 61 per cent and 81 per cent, respectively. When the 17 cases of limb loss were compared to the rest of the series, nonstatistically significant variables included male sex [11 (65%) vs 79 (56%); P = 0.608] and diabetes [12 (71%) vs 80 (57%); P = 0.310]. Statistically significant variables included black race [9 (53%) vs 39 (28%); P = 0.048]; chronic renal failure [6 (35%) vs 12 (9%); P = 0.005], placement to a tibial/pedal artery [15 (88%) vs 107 (62%); P = 0.034], distal anastomosis to the anterior tibial/dorsalis pedis (AT/DP) artery [8 (47%) vs 27 (16%); P = 0.004], and grafts requiring late revision [7 (41%) vs 22 (13%); P = 0.006]. Thirteen (76%) extremities had an intact pedal arch. Nine amputations were performed within 30 days (early group), and eight were performed from 45 days to 20 months (median, 8 months) after bypass placement (late group). The most common primary causes of limb loss in the early group were overwhelming progression of soft-tissue infection despite patent bypass (n = 4; 44%) and insufficient runoff in the foot (n = 3; 33%). In the late group, amputation most often followed long treatment of a chronic proximal diabetic neuropathic foot ulcer with osteomyelitis. Five (63%) grafts in this group were anastomosed to the AT/DP arteries. These data suggest that patients with chronic renal failure, chronic neuropathic heel ulcers, and an AT/DP bypass are at greater risk for amputation despite a working bypass, especially if the graft develops a hemodynamically significant stenosis. Careful judgment and patient selection under these circumstances are thus justified.
Authors:
C G Carsten; S M Taylor; E M Langan; M M Crane
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  64     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  1998 Jan 
Date Detail:
Created Date:  1998-02-19     Completed Date:  1998-02-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  33-7; discussion 37-8     Citation Subset:  IM    
Affiliation:
Department of Surgical Education, Greenville Hospital System, South Carolina 29605, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Amputation*
Anastomosis, Surgical
Blood Vessel Prosthesis Implantation*
Female
Foot Ulcer / complications
Graft Occlusion, Vascular / etiology*,  surgery
Humans
Kidney Failure, Chronic / complications
Leg / blood supply*
Male
Middle Aged
Polytetrafluoroethylene
Postoperative Complications
Prospective Studies
Soft Tissue Infections / etiology,  surgery
Treatment Failure
Vascular Surgical Procedures*
Veins / transplantation
Chemical
Reg. No./Substance:
9002-84-0/Polytetrafluoroethylene

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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