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Prosthetic (ptfe) Bypass To Infrapopliteal Arteries Is A Worthwhile Limb Salvage Procedure
Hasan H. Dosluoglu, MD1, Yana Etkin, MD
2, Frank Veith, MD
3, Mark Adelman, MD
4, Neal Cayne, MD
5, Karan Garg, MD
6, Gregg Landis, MD
2, Richard Neville, MD
7, Enrico Ascher, MD
6.
1SUNY at Buffalo, Buffalo, NY, USA,
2Northwell Health, New Hyde Park, NY, USA,
3Cleveland Clinic Foundation, Cleveland, OH, USA,
4NYU-Langone Medical Center (Ret.), New York, NY, USA,
5NYU-Langone Medical Center, New York, NY, USA,
6NYU-Langone Medical Center, Buffalo, NY, USA,
7Inova Health System, Fairfax, VA, USA.
Objectives: Prosthetic (PTFE) bypasses to infrapopliteal (IP) arteries for limb salvage when other open surgical or endovascular treatment options are impossible are widely regarded as not being worthwhile. The purpose of this study is to show that such bypasses, in patients otherwise facing major amputation, are worthwhile by evaluating their mid and long-term results from 5 centers.
Methods: Four-year life table data for patency (P), limb salvage (LS) and patient survival (PS) was obtained for 110 patients with PTFE IP bypasses from two of the centers with complete follow up of all their patients. From all 5 centers, 35 patients surviving >4 years with a proven patent PTFE IP bypass (ultra-long-term surviving and patent [ULSP]) were collected. Patency was proven by angiography or duplex. Distal anastomotic vein patches (DAVPs) were used in 1/3 of all the bypasses.
Results: From the two centers with complete follow up, at 1-, 2-, 3- and 4-years life table for P was 67±5%, 60±5%, 49±6% and 45±6%; for LS was 72±5%, 68±5%, 63±5% and 61±5; and for PS was 71±5%, 68±5%, 59±5% and 44±5%, respectively. Of the 110 patients from the two centers at 1,2 3 and 4 years, 68, 61, 53 and 39 survived respectively. Of these surviving patients, 51 (75.0%), 42 (68.9%), 29 (54.7%) and 20 (51.3%) had patent IP grafts at 1, 2, 3 and 4 years respectively. The 35 ULSP patients remained in this state for 5.4±2.4% years (range 4-13). Extrapolating from the two center results with 110 patients, 193 patients would have to be treated with an IP PTFE LS bypass to get the 35 that survived >4-13 years with a patent bypass.
Conclusions: Patients requiring IP PTFE LS bypasses have poor 4-year survival. Despite this acceptable mid, long, and ultra-long-term P and LS were achievable in multiple centers in patients facing imminent amputation with no other therapeutic option. Such LS bypasses are worthwhile and should be performed when needed to save ischemic lower limbs.
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