Efficacy of Dual Outflow Infrageniculate Bypasses for Critical Limb Ischemia
Julia Kleene, J C. Hnath, C J. Warner, Y Sternbach, R C. Darling.
Albany Medical Center, Albany, NY, USA.
Efficacy of Dual Outflow Infrageniculate Bypasses for Critical Limb Ischemia
Objective: Determine viability of dual outflow infrageniculate bypass for limb salvage in patients with critical limb ischemia and poor quality outflow vessels.
Methods: Single institution retrospective review from 1999-2016 of bypasses with dual outflow infrageniculate targets. Patient demographics, indication, bypass details, complications, and outcomes were collected
Results: 10 patients underwent dual outflow bypasses to infrageniculate vessels (Table 1). 3 early bypass thromboses resulted in above knee amputation (30%). 7 had longer term patency (70%), however 2 patients only had patency of one outflow bypass during longterm followup.
Conclusions: Dual outflow infrageniculate bypasses may offer a limb salvage option in situations with poor outflow vessels, however enthusiasm for this technique should be tempered by the high rates of limb loss and early death.
Table 1. Dual Outflow Bypass Primary and Secondary Outcomes Results
| Patient | Age | Sex | Indication | Inflow | Conduit | OTF 1 | OTF 2 | Followup (m) | Outcome |
| 1 | 77 | M | Aneurysm | SFA | GSV | Peroneal | AT | 1 | AKA(1month) |
| 2 | 64 | M | Thrombosis | SFA | GSV | Peroneal | PT | 31 | Salvage, peroneal occluded @ 1 month |
| 3 | 82 | M | Gangrene | CFA | GSV | BkPop | DP | 3 | AKA(3months) |
| 4 | 84 | F | Gangrene | CFA | GSV | BKPop | AT | 7 | Salvage, died @ 6 months |
| 5 | 90 | M | Aneurysm | SFA | GSV | TP trunk | PT | N/A | Salvage, died post op day #2 |
| 6 | 61 | M | Thrombosis | CFA | PTFE | TP trunk | PT | 2 | AKA(2 month), died @ 2 months |
| 7 | 79 | M | Gangrene | CFA | GSV | Peroneal | Plantar | 18 | Salvage, peroneal occluded 1 month, died @ 18 months |
| 8 | 54 | F | Gangrene | CFA | LSV/Bas | AT | AT | 2 | Salvage |
| 9 | 68 | M | Gangrene | BKPop | GSV | PT | AT | 1 | Salvage |
| 10 | 61 | M | Aneurysm | SFA | GSV | BKPop | PT | 192 | Salvage |
Superficial femoral artery (SFA), Greater saphenous vein (GSV), Anterior tibial artery (AT), Posterior tibial artery (PT), Dorsalis Pedis (DP), Lesser saphenous vein (LSV), Basilic vein (Bas), Tibeoperoneal trunk (TP trunk), Below Knee popliteal artery (BKPop), Polytetraflouroethylene (PTFE)
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