KUMJ | VOL. 16 | NO. 2 | ISSUE 62 | APRIL-JUNE 2018
Crural Bypass Surgery in Case of Critical Ischemia: Technical Aspects and Results
Thermann F, Karmacharya RM
Abstract: Background
Crural bypass surgery is one of the last options to salvage the leg. Compared to
arterial reconstructions of more proximal localization patency rates are generally less
good. The aim of this retrospective study was to answer the question if crural bypass
surgery is justified. For that we focused on different technicalities, bypass material,
recipient vessel and anticoagulation regimes.
Objective
To know outcome of crural bypass in terms of patency rates, survival rates,
amputation. The difference in outcome is compared in different stages of peripheral
arterial disease and various bypass materials and sites.
Method
Between 07/2013 and 06/2018 we performed 102 crural bypasses (27 female, 75
male; age 44-90 (70) years). Reasons for the bypasses were a critical peripheral
arterial diseases (PAD) (stage III [pain at rest] and IV [necrosis/gangrene] according
to Fontaine). End point of the study was major amputation or death. All patients
were operated on in the same department by two experienced vascular surgeons.
Result
Amputation-free time was 78% after sixmonths and 70% after 24 and 60 months.
Six, 12 and 40 months survival was 83%, 78% and 59%, respectively. Patency rates
were affected by the severity of the disease (stage III vs. stage IV) and so was major
amputation. Autologous bypasses were not associated with a better patency rate.
Minor amputation or the anticoagulation scheme did not influence the long term
results.
Conclusion
The long term survival after crural bypass is good and amputation rates are low,
independent of the vessel of the lower leg used as recipient outflow. Accordingly,
if a bypass is technically feasible, there is no limitation regarding the choice of the
recipient vessel. If possible, autologous vein should be used, but a graft prosthesis
can lead to equally good results. As patients with stage III PAD have better outcomes,
early intervention is recommended in order to avoid deterioration to stage IV.
Keyword : Anticoagulation, Crural bypass, Limb salvage, Recipient vessel
