Axillary-Popliteal Artery Bypass Provides Successful Limb Salvage After Removal of Infected Aortofemoral Grafts

The aim of this study was to evaluate the long-term outcomes of the surgical repair of popliteal artery aneurysms (PAAs), and to analyze the factors associated with graft patency. Between January 1980 and December 2013, 45 limbs were subjected to open surgical repair at Tokyo Medical and Dental Hospital. We retrospectively examined the patients' clinical characteristics, clinical symptoms, and aneurysm-related anatomy. Surgical procedures were performed through a posterior or medial approach using autologous vein or prosthetic graft. Surgical outcomes were evaluated by postoperative mortality, postoperative morbidity, graft patency, and limb salvage. During the study period, 45 limbs (35 patients; mean age, 60 years) underwent open surgical repair. A total of 25 limbs were treated through a posterior approach using 23 autologous vein grafts (AVGs) and 2 expanded polytetrafluoroethylene (ePTFE) grafts. The other 20 limbs were treated through a medial approach using 13 AVGs and 7 ePTFE grafts. During the mean follow-up period of 65 months, the primary patency rates at 1, 3, and 5 years were 88.0%, 75.7%, and 75.7%, respectively, and the limb salvage rates at 1, 3, and 5 years were 97.1%, 91.4%, and 91.4%, respectively. In the univariate analysis, the ligation and bypass grafting affected the primary patency rate significantly, and the ePTFE graft was associated with a poor primary patency in the multivariate analysis (hazard ratio, 17.8). The use of resection or endoaneurysmorrhaphy for PAAs and graft interposition with an AVG might be more effective for the open repair of PAAs.

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Traumatic Anterior Knee Dislocation with Popliteal Artery Injury: The Importance of a Prompt Diagnosis and Treatment to Obtain Lower Limb Salvage

Annals of Vascular Surgery ◽

10.1016/j.avsg.2016.12.020 ◽

2017 ◽

Vol 43 ◽

pp. 309.e1-309.e3 ◽

Cited By ~ 2

Author(s):

Mafalda Massara ◽

Roberto Prunella ◽

Giovanni De Caridi ◽

Domenico Cito ◽

Raffaele Serra ◽

...

Keyword(s):

Limb Salvage ◽

Popliteal Artery ◽

Lower Limb ◽

Knee Dislocation ◽

Diagnosis And Treatment ◽

Artery Injury ◽

Anterior Knee ◽

Prompt Diagnosis

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Femoral Artery to Prosthetic Graft Anastomotic Dehiscence Owing to Infection: Successful Treatment with Arterial Reconstruction and Limb Salvage

Vascular ◽

10.1258/rsmvasc.13.6.355 ◽

2005 ◽

Vol 13 (6) ◽

pp. 355-357 ◽

Cited By ~ 1

Author(s):

Kenneth A. Goldstein ◽

Frank J. Veith ◽

Takao Ohki ◽

Nicholas J. Gargiulo ◽

Evan C. Lipsitz

Keyword(s):

Limb Salvage ◽

Femoral Artery ◽

Artery Bypass ◽

Balloon Catheter ◽

Anastomotic Dehiscence ◽

Prosthetic Graft ◽

Anterior Tibial Artery ◽

Skeletal Traction ◽

Os Calcis ◽

Anterior Tibial

A 66-year-old man had foot gangrene and a fixed contracture of the knee following two failed femoropopliteal bypasses, one with vein and one with polytetrafluoroethylene (PTFE). An external iliac to anterior tibial artery bypass and skeletal traction via the os calcis resulted in limb salvage and successful normal ambulation. After 3 months, he ruptured the infected femoral anastomosis of the failed PTFE femoropopliteal bypass with external bleeding. The use of arteriography and a balloon catheter to obtain proximal control allowed arterial repair, removal of the graft, and preservation of flow within a patent common and deep femoral artery. This flow preservation maintained the viability and function of the limb when the anterior tibial bypass closed 4 years later, and the limb continues to be fully functional 3 years later. Aggressive secondary attempts at limb salvage are worthwhile even in unfavorable circumstances.

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Comparison of propaten heparin-bonded vascular graft with distal anastomotic patch versus autogenous saphenous vein graft in tibial artery bypass

Vascular ◽

10.1177/1708538117717141 ◽

2017 ◽

Vol 26 (2) ◽

pp. 117-125 ◽

Cited By ~ 3

Author(s):

Jeremy Kaisar ◽

Aaron Chen ◽

Mathew Cheung ◽

Elias Kfoury ◽

Carlos F Bechara ◽

...

Keyword(s):

Limb Salvage ◽

Saphenous Vein ◽

Vein Graft ◽

Saphenous Vein Graft ◽

Artery Bypass ◽

Length Of Hospital Stay ◽

Primary Patency ◽

Secondary Patency ◽

Graft Occlusion ◽

Tibial Artery

Introduction Heparin-bonded expanded polytetrafluoroethylene grafts (Propaten, WL Gore, Flagstaff, AZ, USA) have been shown to have superior patency compared to standard prosthetic grafts in leg bypass. This study analyzed the outcomes of Propaten grafts with distal anastomotic patch versus autogenous saphenous vein grafts in tibial artery bypass. Methods A retrospective analysis of prospective collected data was performed during a recent 15-year period. Sixty-two Propaten bypass grafts with distal anastomotic patch (Propaten group) were compared with 46 saphenous vein graft (vein group). Pertinent clinical variables including graft patency and limb salvage were analyzed. Results Both groups had similar clinical risk factors, bypass indications, and target vessel for tibial artery anastomoses. Decreased trends of operative time (196 ± 34 min vs. 287 ± 65 min, p = 0.07) and length of hospital stay (5.2 ± 2.3 days vs. 7.5 ± 3.6, p = 0.08) were noted in the Propaten group compared to the vein group. Similar primary patency rates were noted at four years between the Propaten and vein groups (85%, 71%, 64%, and 57%, vs. 87%, 78%, 67%, and 61% respectively; p = 0.97). Both groups had comparable secondary patency rates yearly in four years (the Propaten group: 84%, 76%, 74%, and 67%, respectively; the vein group: 88%, 79%, 76%, and 72%, respectively; p = 0.94). The limb salvage rates were equivalent between the Propaten and vein group at four years (84% vs. 92%, p = 0.89). Multivariate analysis showed active tobacco usage and poor run-off score as predictors for graft occlusion. Conclusions Propaten grafts with distal anastomotic patch have similar clinical outcomes compared to the saphenous vein graft in tibial artery bypass. Our data support the use of Propaten graft with distal anastomotic patch as a viable conduit of choice in patients undergoing tibial artery bypass.

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