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 Impact of Pedal Arch Quality in Distal Bypass Grafts Explored

Study Examines Amputation-free Survival, Patency Rates and Healing in Critical Limb Ischemia Patients 

June 8, 2012    Contact: Sue Crosson-Knutson    312-334-2311   scknutson@vascularsociety.org

WASHINGTON, D.C.— Pedal arch quality on amputation-free survival and patency rates of distal bypass grafts, and the time and rate of healing and tissue loss following direct angiosomere vascularization (DAR) in critical limb ischemia (CLI) patients was revealed today at the 66th Vascular Annual Meeting presented by the Society for Vascular Surgery®. 

Co-author Hani Slim, MD, MRCS from the department of vascular surgery, King's College Hospital in London, said that the study revealed the quality of the pedal arch did not impact the patency or the amputation-free survival rates. He noted that in contrast the healing and time-to-healing rates were directly influenced by the quality of the pedal arch rather than DAR.

A total of 167 patients undergoing distal bypass for CLI (Rutherford 4-6) between 2001 and 2004 were divided in groups taking into consideration the state of the pedal arch and DAR vs. non-DAR. Based on angiography, the pedal arch was divided into three groups; complete pedal arch (CPA), 31 patients; incomplete pedal arch (IPA), 104 patients; and no pedal arch (NPA) 32 patients. Kaplan-Meier was used to analyze primary and secondary patency rates at 12 months, amputation-free survival at 48 months, and the rate of healing and time-to-healing of tissue loss.

During the first year the CPA group primary patency rate was 58.4 percent; the secondary patency rate, 86.0 percent; and amputation-free survival at 48 months was 67.2 percent. The IPA group percentages for the same criteria were 54.6 percent, 84.7 percent and 69.7 percent; the NPA figures were 63.8 percent, 88.8 percent and 45.9 percent. There were no statistical significance difference for the same criteria among the three groups (p=0.5168, 0.8940, and 0.3883) respectively. 

Out of the 167 bypasses, incidence of diabetes mellitus and chronic renal failure was similar in all groups and 141 had foot tissue loss. The CPA group 93 percent of tissue loss with DAR healed (median time-to-healing; 56 days) compared to 100 percent in the non-DAR (98 days). Similarly in the IPA group, 95 percent with DAR healed (106 days) compared to 90 percent in the non-DAR (94 days). While in the NPA group only 75 percent with DAR healed (81 days) compared to 73 percent in the non-DAR (148 days). There was only statistical significant difference in the time-to-healing between CPA and IPA compared to NPA group (p=0.0141).
 
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