Results of peripheral bypass surgery in patients with critical limb ischemia. CRITISCH registry

摘要

Aim. The outcomes of patients with critical limb ischemia (CLI) who underwent lower extremity bypass surgery were analyzed based on the data in the CRITISCH registry with respect to the localization of the distal anastomosis and type of bypass material. Patients and methods. In total 284 patients with a lower extremity bypass (group 1: 75 patients with bypass above the knee, group 2:80 patients with bypass below the knee and group 3: 129 patients with crural or pedal bypass) were included in this study. The graft material included 159 autologous saphenous vein grafts and 125 prosthetic grafts. Results. There were no perioperative complications in 191 out of the 284 patients (67.3) and in 236 out of the 284 (83.1) patients the bypass remained open at discharge from hospital. An uneventful postoperative course was documented in 76 of the patients in group 1, 62.5 in group 2 and 65.1 in group 3. The amputation-free survival at 1 year was 86 in group 1, 65 in group 2 and 69 in group 3. In patients with a bypass above the knee prosthetic grafts were at least not inferior to vein grafts (amputation-free survival at 1 year: prosthetic bypasses 92, saphenous vein grafts 71 , p = 0.147), while in the group with a crural or pedal bypass, vein grafts showed a better amputation-free survival at 1 year (76) compared with prosthetic bypasses (56, p = 0.105). Patients with a PIII CLI risk scores <= 3 exhibited a better amputation-free survival at 1 year of 78 compared to patients with PIII CLI risk scores 4-7 with 69 (p = 0.053). The same applied to patients with Rutherford stage 4 versus Rutherford stage 6 CLI. Conclusions. In patients with CLI and a bypass above the knee, vein grafts provide no benefits for at least 1 year follow-up when compared with prosthetic grafts. But in more distal anastomoses vein grafts should be preferred.