Infrainguinal arterial reconstruction for claudication: Is it worth the risk? An analysis of 409 procedures

Purpose: Infrainguinal reconstruction traditionally has been reserved for p atients with limb-threatening ischemia. Surgery for debilitating claudicati on, however, has been discouraged as a result of the perceived fear of bypa ss graft failure, limb loss, and significant perioperative complications th at may be worse than the natural history of the disease. In this study, the results of infrainguinal reconstructions for claudication performed during the past 10 years were evaluated for bypass graft patency, limb loss, and long-term survival rates. Methods: Data were collected and reviewed from the vascular registry, the o ffice charts, and the hospital records for patients who underwent infraingu inal bypass grafting for claudication. Results: From 1987 to 1997, 409 infrainguinal reconstructions were performe d for claudication (9% of all infrainguinal reconstructions in our unit). T he patient population had the following demographics: 73% men, 28% with dia betes, 54% smokers, and an average age of 64 years (range, 24 to 91 years). Inflow was from the following arteries: iliac artery/graft, 10%; common fe moral artery, 52%; superficial femoral artery, 19%; profunda femoris artery , 16%; and popliteal artery, 2%. The outflow vessels were the following art eries: 165 above-knee popliteal arteries (40%), 150 below-knee popliteal ar teries (37%), and 94 tibial vessels (23%). The operative mortality rate was 0%, and one limb was lost in the series from distal embolization. The prim ary patency rates were 62%, 77%, and 86% for above-knee popliteal artery, b elow-knee popliteal artery, and tibial vessel reconstructions at 4 years, a nd the secondary patency rates were 64%, 81%, and 90%, respectively. Cumula tive patient survival rates were 93% and 80% at 4 and 6 years as compared w ith 65% and 52%, respectively, for infrainguinal reconstructions performed for limb salvage. Conclusion: Infrainguinal arterial reconstruction for disabling claudicatio n is a safe and durable procedure in selected patients. These data indicate that concern for limb loss, death, and limited life span of the patients w ith this disease may not be warranted.