Hani Slim, Hany Zayed, Michael Edmonds, Hisham Rashid
Vascular Surgery, King's Collage Hospital, London, United Kingdom.
OBJECTIVES: To evaluate the impact of pedal arch quality on the amputation-free survival and patency rates of distal bypass grafts and also its direct impact on rate of healing and time-to-healing of tissue loss following direct angiosome revascularization in patients with critical limb ischemia (CLI).
METHODS: Between 2004 and 2011, patients undergoing distal bypass for CLI (Rutherford 4-6) were divided in groups taking in consideration the state of the pedal arch and direct angiosome revascularization (DAR) and non-DAR.
Based on angiography, the pedal arch was divided into 3 groups; complete pedal arch (CPA), incomplete pedal arch (IPA) and no pedal arch (NPA).
Kaplan-Meier was used to analyze patency rates at 12 months, amputation-free survival at 48 months, the rate of healing and time-to-healing of tissue loss.
RESULTS: Total of 167 bypasses was included in the analysis. Thirty-one (19%) had CPA, 104 (62%) IPA and 32 (19%) had NPA. Incidence of diabetes mellitus and chronic renal failure was similar in all groups.
The primary and secondary patency rates at 1-year as well as the amputation-free survival at 48 months for all groups were;
CPA: 58.4%, 86.0% and 67.2% (p=0.5168)
IPA: 54.6%, 84.7% and 69.7% (p=0.8940)
NPA: 63.8%, 88.8% and 45.9% (p=0.3883)
Out of the 167 bypasses, 141 had foot tissue loss. In the CPA group 93% of tissue loss with DAR healed (median time-to-healing; 56 days) compared to 100% in the non-DAR (98 days). Similarly in the IPA group 95% with DAR healed (106 days) compared to 90% in the non-DAR (94 days). While in the NPA group only 75% with DAR healed (81 days) compared to 73% in the non-DAR (148 days). There was only statistical significant difference in the time-to-healing between CPA/IPA versus NPA group (p=0.0141).
CONCLUSIONS: The quality of the pedal arch did not influence the patency or the amputation-free survival rates. However, the healing and time-to-healing rates were directly influenced by the quality of the pedal arch rather than the angiosome revascularized.
AUTHOR DISCLOSURES: M. Edmonds, Nothing to disclose; H. Rashid, Nothing to disclose; H. Slim, Nothing to disclose; H. Zayed, Nothing to disclose.
Posted April 2012