Limb salvage after successful pedal bypass grafting is associated with improved long-term survival

Objectives: Assessments of outcome after reconstruction for critical limb i schemia frequently ignore functional result and long-term morbidity and mor tality. This study was undertaken to identify factors affecting long-term c linical outcome and survival after pedal bypass grafting. Methods: The clinical data of 256 consecutive patients who underwent pedal bypass grafting for critical limb ischemia over a 12-year period were retro spectively analyzed. Results: A total of 174 men and 82 women (median age, 70 years; range, 30-9 1 years) underwent 280 pedal bypass graft placements with autologous vein. Seventy-five percent of the patients were diabetic, and 20% had renal insuf ficiency (serum creatinine level > 2 mg/dL). The in-hospital mortality rate was 1.6% (4/256). The mean follow-up was 2.7 years (range, 0.1-10.1 years) . Rates of primary and secondary patency, limb salvage, and survival at 5 y ears were 58%, 71%, 78%, 60%, respectively. A total of 160 limbs (57%) requ ired additional interventions. Nineteen early graft thrombectomies/revision s and nine early amputations were performed. One hundred thirty-eight late interventions included 31 graft salvage procedures, 27 wound debridements, and 34 minor and 42 major amputations. At last follow-up or death, 219 (78% ) limbs were being used for ambulation. End-stage renal disease (ESRD) and composite vein grafts predicted limb loss (P < .001, P < .001, respectively ). Overall survival at 5 years was 60%. Survival after amputation was 79%, 53%, and 26% at 1, 3, and 5 years. Amputation and ESRD predicted higher mor tality (P = .014, P = .0001, respectively). Conclusions: Pedal bypass grafting resulted in good functional limb salvage , but at the expense of multiple interventions in more than half the cases. ESRD and composite vein graft were associated with poor long-term limb sal vage. Amputation after bypass grafting was associated with significantly wo rse long-term survival.