Comparison of Long-Term Results of Leg Arterial Bypasses between the Patients with Chronic Critical Limb Ischemia and Claudication

Yun, Woo Sung; Kim, Young Wook; Huh, Seung; Kim, Sang Gul; Park, Ho Yong; Moon, Ji Young

Abstract

Patients with chronic leg arterial occlusion usually present with claudication or chronic critical limb ischemia (CCLI). Infrainguinal bypasses are usually indicated for those patients with CCLI and intermittent claudication that is causing severe disability. PURPOSE: To observe the differences in outcomes of leg arterial bypasses between the patients with CCLI and disabling claudication. METHODS: Three hundreds consecutive patients, with 400 leg bypasses (327 vein grafts and 67 prosthetic grafts, and 6 composite grafts), were enrolled, and stratified into CCLI (n= 245) and disabling claudication (n=155) groups. After a comparison of their demographic features, frequency of coexisting diseases and details of bypass procedures, the early and long-term results of leg arterial bypasses between 2 groups were also compared. The graft patency was determined by periodic measurements of the ankle brachial index and duplex scanning, and the patient survival was determined with the help of a governmental office database. The graft patency, patient survival and amputation-free survival rates were calculated using the Kaplan Meier method, and compared with Log rank tests. RESULTS: The demographic features and frequency of coexisting morbidity were not significantly different between the 2 groups, with the exception of a female preponderance in the CCLI group. Infrapopliteal bypasses were more commonly performed in the CCLI group 40 vs. 20%, P<.0005) and the primary graft patencies were significantly higher in the claudication group (at 3, 5 and 7 years; 90.2, 74.6 and 63.9% vs. 61.9, 58.0 and 50.7%, P<.0005) only after vein bypass. The patient survivals were also significantly longer in the claudication compared to the CCLI group (at 3, 5 and 7 years; 94.7, 74.8 and 68.5% vs. 51.0, 30.8 and 20.5%, P<.0005). CONCLUSION: Despite there being no significant difference in the age or frequencies of coexisting morbidity, a significantly longer patient survival was found in the claudication group. Considering the longer vein graft patency of the claudication group was inconclusive in this retrospective study, an infrainguinal bypass, with an autologous vein, should be considered as a primary treatment for better long-term results in selected claudication patients.