Outcomes of Infrainguinal Arterial Bypasses for the Patients with Atherosclerotic Lower Extremity Arterial Occlusive Disease

Go, Chang dae; Kim, Young wook

Abstract

Surgery has been a well accepted treatment modality for the advanced lower extremity arterial occlusive disease. From March 1993 through February 1997, 121 limbs with atherosclerosis obliterans (ASO) in 99 patients were treated with infrainguinal bypasses at Department of Surgery, Kyungpook National University Hospital. Indications for the infrainguinal bypasses were intermittent claudication in 66 limbs(54.5%) and limb threatening ischemia in 55 limbs(45.5%). Conduits used for the arterial bypasses were 92 autogenous veins(79 reversed saphenous veins, 7 in situ veins, 2 nonreversed translocated veins, and 4 spliced vein grafts), 21 PTFE grafts, and 8 composite grafts. The operations were performed as the primary procedure in 112 limbs(92.6%) and as redo bypasses in 9 limbs(7.4%). The levels of distal anastomosis were above-knee popliteal artery in 34, below-knee popliteal artery in 57, posterior tibial artery in 19, anterior tibial artery in 4, peronal artery in 5, and inframalleolar artery in 2 limbs. Associated inflow arterial procedures were performed in 45 limbs(37.2%), which included 17 aortofemoral, 24 femorofemoral, 3 axillofemoral bypasses and 1 iliac PTA. Assisted primary patency rates at 4 years after graft implantation were 82.8% in reversed vein grafts(including 4 spliced vein grafts) and 62.8% in prosthetic and composite grafts according to the life table method. Clinical outcomes categorized by the revised SVS/ISCVS standard showed better results in claudication group than in limb threatening ischemia group. Limb salvage rate in the patients with limb threatening ischemia (n=55) was 87.2% at 4 years after graft implantation and operative mortality was absent.