Pedal Bypass Surgery Prevents Amputation in Patients with Critical Lower Limb Ischemia: A Single Center Experience of 99 Pedal Bypass Operations

Trine Marie Mejnert Jørgensen*, Jørn Michael Jepsen, Amrit Rai, Christian Hallenberg, Kim Christian Houlind

*Kontaktforfatter for dette arbejde

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Background: Bypass surgery below the ankle is now rarely used as prevention of major amputations
due to critical limb ischemia. We aimed to investigate results after bypass surgery below the ankle
performed at a single center in Denmark. The study was designed as a retrospective, single centre
study and endpoints were major amputations, overall survival as well as amputation-free and
intervention-free survival.
Methods: We included all patients undergoing pedal bypass surgery at a single vascular centre in
Denmark. Baseline was set as date of surgery and patients were followed until amputation, death
or end of study. The mean amputation-free and overall survival as well as primary and secondary
patency was calculated using Kaplan Meier survival analysis. Cox regression analysis was performed
to investigate possible significant co-variables.
Results: We included 93 patients with 99 bypasses. 16 patients (16.5%) experienced one or more
open and/or endovascular bypass revisions and 26 (28%) experienced major amputation. Mean
patency, primary as well as secondary, was 2.6 years. Mean amputation-free survival was 2.9 years
and mean overall survival 3.9 years.
Conclusion: This study shows that in many cases bypass surgery to a pedal artery can prevent
major amputation in patients with critical limb ischemia and that patients undergoing this kind of
surgery have an expected amputation-free survival comparable to patients undergoing crural bypass
operations above the ankle reported in earlier studies. Therefore, this type of operation should be
considered as treatment to prevent amputation in patients with no graftable arteries on the lower
leg above the ankle.
TidsskriftClinics in Surgery
Antal sider6
StatusUdgivet - 24. aug. 2020