Dl. Akers et Rl. Hewitt, MANAGEMENT OF THE FAILED PRIMARY INFRAINGUINAL RECONSTRUCTION - TREATMENT OPTIONS AND LONG-TERM OUTCOME, Vascular surgery, 30(4), 1996, pp. 281-288
Patients presenting with critical limb ischemia following failed infra
inguinal grafts have been reported to have a significant amputation ra
te and reduced long-term survival. The authors reviewed their three-ye
ar experience with 33 patients with failed infrainguinal reconstructio
n. The median age was 63.1 years of age (range forty-three to eighty-s
even years). There were 19 women and 14 men. Risk factors included the
following: hypertension 31 (94%), diabetes 21 (64%), and tobacco use
30 (91%). All patients had limb-threatening ischemia, 15 had gangrene
(45.4%), 8 had ulceration (24.2%), and 10 had rest pain 10 (30.3%). Th
ere had been 42 previous revascularizations (1.27 per patient, range 1
to 6). The authors performed 45 revascularization operations (1.36 pe
r patient, range 1 to 4). Inflow was as follows: common femoral artery
in 29 (64.4%), superficial femoral artery in 9 (20%), profunda femori
s in 4 (8.9%), aortobifemoral graft limb in 2 (4.4%), and femoral-femo
ral bypass graft in 1 (2.2%). Outflow was as follows: posterior tibial
artery 12 (26.7%), peroneal artery in 17 (37.8%), anterior tibial art
ery in 7 (15.6%), popliteal artery in 5 (11.1%), and tibioperoneal tru
nk in 4 (8.9%). The conduits were as follows: great saphenous vein (GS
V) from the opposite lower limb in 8 (17.8%), GSV/lesser saphenous vei
n (LSV) composites in 8 (17.8%), expanded polytetrafluoroethylene in (
ePTFE) 5 (11.1%), LSV composite in 10 (22.2%), ePTFE/GSV composite in
5 (11.1%), cadaveric vein in 2 (4.4%), superficial femoral vein/ePTFE
composite in 2 (4.4%), endarterectomized superficial femoral artery/GS
V composite in 1 (2.2%), GSV/upper limb vein composite in 1 (2.2%); an
d upper limb vein in 3 (6.7%). There was one perioperative death (2.2%
). Six patients died during the follow-up period (74.1% survival). Lim
b salvage was obtained in 28 patients (83.1%). Cumulative secondary pa
tency was 73.2% at three years. These results indicate that: (1) aggre
ssive revascularization for failed infrainguinal grafts can result in
significant limb salvage, and (2) Long-term survival is common in this
patient population.