+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Femorotibial bypass for claudication: Do results justify an aggressive approach?

Femorotibial bypass for claudication: Do results justify an aggressive approach?

Journal of Vascular Surgery 21(6): 873-881

Purpose: The role of infrainguinal arterial reconstructive surgery for claudication is controversial. We reviewed the results of femorotibial bypass procedures performed in a select group of patients with disabling claudication in an attempt to define a role for this aggressive approach. Methods: Data were retrieved from the vascular registry, and hospital records were obtained for all patients undergoing femorotibial reconstruction for disabling claudication during the past 16 years at Brigham and Women's Hospital. Follow-up interviews were obtained to assess overall health, walking impairment, functional status, and patient satisfaction. Results: During a 16-year period a total of 57 tibial reconstructions were performed in 53 patients for claudication (5% of all infrainguinal vein reconstructions). Autogenous vein conduit was used in all cases, most of which (70%) involved the greater saphenous vein in situ. Distal anastamoses were to the tibioperoneal trunk (12%), anterior tibial (18%), posterior tibial (47%), and peroneal (23%) arteries. Major complications occurred in 9%, and no perioperative deaths occurred. Overall 5-year survival was 54% +- 15%, and no major amputations were performed. Cumulative primary and secondary graft patency at 5 years were 81% +- 60% and 86% +- 5%, respectively. Patency rates were significantly better than those achieved in a concurrent series of tibial bypasses for limb salvage and were equivalent to those achieved with femoropopliteal bypass for claudication. Interviewed patients reported improved walking distance, reduced claudication, and a high degree of overall satisfaction with their operation. Conclusion: Results obtained with femorotibial bypass performed for claudication were superior to those obtained for limb salvage and were equivalent to those obtained with femoropopliteal bypass for claudication. The results obtained in this highly selected cohort suggest that patients at low risk with significant functional impairment from claudication, available autogenous vein, and suitable tibial outflow to the ischemic muscular bed can be offered revascularization with the expectation of durable long-term results.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 008682035

Download citation: RISBibTeXText

PMID: 7776466

DOI: 10.1016/S0741-5214(95)70214-8

Related references

Carotid endarterectomy for unstable and compelling neurologic conditions: Do results justify an aggressive approach?. Journal of Vascular Surgery 19(1): 32-42, 1994

Femorotibial ankylosis in a child with Roberts syndrome: an "aggressive" approach to habilitation. Journal of Pediatric Orthopedics 27(8): 926-929, 2008

Sequential femorotibial bypass: clinical results. Canadian Journal of Surgery. Journal Canadien de Chirurgie 23(1): 78-80, 1980

Femorotibial bypass grafts with sequential technique. Clinical results. Archives of Surgery 116(5): 709-714, 1981

Long-term results of femorotibial bypass with vein or polytetrafluoroethylene. British Journal of Surgery 86(1): 137-137, 1999

Do results justify an aggressive strategy targeting the pedal arteries for limb salvage?. Journal Of Surgical Research. 59(4): 450-454, 1995

Results of femoropopliteal and femorotibial greater saphenous vein in situ bypass. Life table analysis. International Angiology 11(2): 94-105, 1992

Femoropopliteal and femorotibial bypass procedures on patients with diabetes mellitus: Medium term follow-up results. Cerrahpasa Tip Dergisi 30(3): 203-206, July-Sept, 1999

Trauma patients 75 years and older: long-term follow-up results justify aggressive management. Journal of Trauma 44(4): 618-23; Discussion 623, 1998

Revascularization of the lower extremities by femorotibial bypass with an autologous saphenous vein. Surgical technic and long-term results. Amb 27(9): 271-274, 1981

Regarding "Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: do the results justify an attempt before bypass grafting?". Journal of Vascular Surgery 30(2): 386-387, 1999

Long-term results justify autogenous infrainguinal bypass grafting in patients with end-stage renal failure. Journal of Vascular Surgery 34(1): 27-33, 2001

Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: Do the results justify an attempt before bypass grafting?. Journal of Vascular Surgery 28(6): 1066-1071, 1998