Distal versus ultradistal bypass grafts: amputation-free survival and patency rates in patients with critical leg ischaemia

H Slim, A Tiwari, A Ahmed, J C Ritter, H Zayed, H Rashid
European Journal of Vascular and Endovascular Surgery 2011, 42 (1): 83-8

OBJECTIVES: Compare the outcome of distal (bypass to the crural arteries) versus ultradistal (bypass to the pedal arteries) bypasses in patients with critical leg ischaemia (CLI).

DESIGN: Retrospective analysis of prospectively collected data of patients with CLI undergoing infra-popliteal bypass surgery is performed.

MATERIALS AND METHODS: Patients undergoing infra-popliteal bypass at a single institution between 2004 and 2010 are included. Patency rates at 1-year and amputation-free survival at 12 and 48 months are analysed.

RESULTS: Two hundred and thirty bypasses were performed in 209 consecutive patients (156 men, median age; 76 years, range; 19-96 years). One hundred and seventy nine (78%) bypass were classified as distal and 51 (22%) as ultradistal. The incidence of diabetes mellitus was significantly higher in the ultradistal group (p=0.0025). At 1-year, the distal group primary, assisted-primary and secondary patency rates were 61.7%, 83.1% and 87.4% compared to 61.9%, 87.4% and 87.4% in the ultradistal group respectively. Amputation-free survival at 12 and 48 months was 82.9% and 61.5% in the distal group compared to 83.0% and 64.9% in the ultradistal group.

CONCLUSIONS: This study show that both distal and ultradistal bypass have comparable outcome regardless of the co-morbidities. The authors believe that elderly patients should be offered ultradistal bypass if indicated to avoid major amputation.

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