Crural or pedal artery revascularisation for limb salvage: is it justified

medical decision making; peripheral vascular disease; critical limb ischernia; limb salvage; lower limb amputation; femorotibial bypass; pedal arteries; health-related quality of life; cost-effectiveness; health-care resources

Abstract :

[en] With the ageing of population, the incidence of limb-threatening ischemia increases. In chronic critical limb ischemia, peripheral arterial occlusive disease almost always involves infrainguinal and infragenicular vessels. Fortunately, recent advances in vascular surgery made arterial reconstruction of crural and pedal vessels possible. Should crural or pedal bypass surgery be offered to these frail, polyvascular patients, or is primary amputation a preferable treatment option in case of advanced limb-threatening ischemia? In order to answer this controversial question, the author analysed recent literature data on the feasibility and durability of infrapopliteal bypasses. The quality of life was also considered as an outcome measure. Finally, the cost-effectiveness of both treatment modalities (limb-saving distal bypass versus primary amputation) was assessed.

Disciplines :

Surgery

Author, co-author :

Van Damme, Hendrik ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques

Language :

English

Title :

Crural or pedal artery revascularisation for limb salvage: is it justified

Publication date :

April 2004

Journal title :

Acta Chirurgica Belgica

ISSN :

1784-3421

eISSN :

2577-0160

Publisher :

Acta Medical Belgica, Brussels, Belgium

Volume :

104

Issue :

Pages :

148-157

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 25 February 2011

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Bibliography

European Working Group on Critical Leg Ischaemia. Second European Consensus Document on chronic critical leg ischaemia. Eur J Vasc Surg, 1992, 6 (suppl A) : 1-32.
TransAtlantic InterSociety Consensus Document on Revascularisation (TASC). J Vasc Surg, 2000, 31 (suppl) : S1-S236.
BERCELI S. A., CHAN A. K., POMPOSELLI F. B. Jr, GIBBONS G. W., CAMPBELL D. R., AKBARI C. M., BROPHY D. T., LOGERFO F. W. Efficacy of dorsal pedal artery bypass in limb salvage for ischemic heel ulcers. J Vasc Surg, 1999, 30 : 499-508.
ROBISON J. G., CROSS M. A., BROTHERS T. E., ELLIOTT B. M. Do results justify an aggressive strategy targeting the pedal arteries for limb salvage? J Surg Res, 1995, 59 : 450-454.
APELQVIST J., BAKKER K., VAN HOUTUM W. H., NABUURS-FRANSSEN M. H., SCHAPER N. C. (International Working Group on the Diabetic Foot). International consensus and practical guidelines on the management and the prevention of the diabetic foot. Diabetes Metab Res Rev, 2000, 16 (suppl 1) : S84-S92.
CHANG J. B., STEIN T. A. Infrainguinal revascularizations in octogenarians and septuagenarians. J Vasc Surg, 2001, 3 : 133-138.
CONTE M. S., BELKIN M., UPCHURCH G. R., MANNICK J. A., WHITTEMORE A. D., DONALDSON M. C. Impact of increasing comorbidity on infrainguinal reconstruction : a 20-year perspective. Ann Surg, 2000, 233 : 445-452.
RAFFETTO J. D., CHEN M. N., LAMORTE W. W., SEIDMAN C. S., EBERHARDT R. T., WOODSON J., GIBBONS G. W., MENZOIAN J. O. Factors that predict site of outflow target artery anastomosis in infrainguinal revascularization. J Vasc Surg, 2002, 35 : 1093-1099.
VAN DAMME H. Tibial artery revascularization (Technical note). Acta Chir Belg, 2002, 102 : 216-218.
SHAH D. M., DARLING R. C. 3rd, CHANG B. B., FITZGERALD K. M., PATY P. S., LEATHER R. P. Long-term results of in situ saphenous vein bypass. Analysis of 2058 cases. Ann Surg, 1995, 222 : 438-448.
HARRIS P., JONES D., How T., e.a. A prospectively randomised clinical trial to compare reversed and in situ vein graft for femoropopliteal bypass. Br J Surg, 1987, 74 : 252-255.
CHEW D. K., OWENS C. D., BELKIN M., DONALDSON M. C., WHITTEMORE A. D., MANNICK J. A., CONTE M. S. Bypass in the absence of ipsilateral greater saphenous vein : safety and superiority of the contralateral greater saphenous vein. J Vasc Surg, 2002, 35 : 1085-1092.
TARRY W. C., WALSCH D. B., BIRKMEYER N. J., FILLINGER M. F., ZWOLAK R. M., CRONENWETT J. L. Fate of the contralateral leg after infrainguinal bypass. J Vasc Surg, 1998, 27 : 1039-1048.
REED A. B., CONTE M. S., BELKIN M., MANNICK J. A., WHITTEMORE A. D., DONALDSON M. C. Usefulness of autogenous bypass grafts originating distal to the groin. J Vasc Surg, 2002, 35 : 48-55.
POMPOSELLI F. B. Jr, KANSAL N., HAMDAN A., BELFIELD A., SHEAHAN M., CAMPBELL D. R., SKILLMAN J., LOGERFO F. W. A decade of experience with dorsalis pedis artery bypass : analysis of outcome in more than 1000 cases. J Vasc Surg, 2003, 37 : 307-315.
SHAH D. M., DARLING R. C. 3RD, CHANG B. B., BOCK D. E., LEATHER R. P. Durability of short bypasses to infragenicular arteries. Eur J Vasc Endovasc Surg, 1995, 10 : 440-444.
KREIENBERG P. B., DARLING R. V. 3 RD, CHANG B. B., CHAMPAGNE B. J., PATY P. S., RODDY S. P., LLOYD W. E., OZSVATH K. J., SHAH D. M. Early results of a prospective randomized trial of spliced vein versus polytetrafluoroethylene graft with a distal vein cuff for limb-threatening ischemia. J Vasc Surg, 2002, 35 : 299-306.
STONEBRIDGE P., NAIDU S., COLGAN M., MOORE D., SHANIK D., MCCOLLUM P. Tibial and peroneal artery bypasses using polytetrafluoroethylene (PTFE) with an interposition vein cuff. J Roy Coll Surg Edinburg, 2000, 45 : 17-20.
FARBER A., MAJOR K., WAGNER W. H., COHEN J. L., COSSMAN D. V., LAUTERBACH S. R., LEVIN P. M. Cryopreserved saphenous vein allografts in infrainguinal revascularization : analysis of 240 grafts. J Vasc Surg, 2003, 38 : 15-21.
FEINGLASS J., PEARCE W. H., MARTIN G. J., GIBBS J., COWPER D., SORENSEN M., KHURI S., DALEY J., HENDERSON W. G. Postoperative and amputation-free survival outcomes after femorodistal bypass grafting surgery : findings from the Department of Veterans Affairs National Surgical Quality Improvement Program. J Vasc Surg, 2001, 34 : 283-290.
IDU M. M., BLANKENTEIN J. D., DE GIER P., TRUYEN E., BUTH J. Impact of a color-flow duplex surveillance program on infrainguinal vein graft patency : a five-year experience. J Vasc Surg, 1993, 17 : 42-53.
SCHNEIDER J. R., WALSH D. B., MCDANIEL M. D., ZWOLAK R. M., BESSO S. R., CRONENWETT J. L. Pedal bypass versus tibial bypass with autogenous vein : a comparison of outcome and hemodynamic results. J Vasc Surg, 1993, 17 : 1029-1040.
DARLING C., CHANG B., SHAH D., LEATHER R. Choice of peroneal or dorsalis pedis artery bypass for limb salvage. Sem Vasc Surg, 1997, 10: 17-22.
KLAMER T. W., LAMBERT G. E. Jr, RICHARDSON J. D., BANIS J. C. Jr, GARRISON R. N. Utility of inframalleolar arterial bypass grafting. J Vasc Surg, 1990, 11 : 164-170.
CONNORS J. P., WALSH D. B., NELSON P. R., POWELL R. J., FILLINGER M. F., ZWOLAK R. M., CRONENWETT J. L. Pedal branch artery bypass : a viable limb salvage option. J Vasc Surg, 2000, 32: 1071-1079.
BERGAMINI T. M., GEORGE S. M. Jr, MASSEY H. T., HENKE P. K., KLAMER T. W., LAMBERT G. E. JR, BANIS J. C. JR, MILLER F. B., GARRISON R. N., RICHARDSON J. D. Pedal or peroneal bypass : which is better when both are patent? J Vasc Surg, 1994, 20 : 347-356.
ABOU-ZAMZAM A. M. Jr, MONETA G. L., LEE R. W., NEHLER M. R., TAYLOR L. M. Jr, PORTER JM. Peroneal bypass is equivalent to inframalleolar bypass for ischemic pedal gangrene. Arch Surg, 1996, 131 : 894-899.
TREIMAN G. S., ODERICH G. S., ASHRAFI A., SCHNEIDER P. A. Management of ischemic heel ulceration and gangrene : An evaluation of factors associated with successful healing. J Vasc Surg, 2000, 31 : 1110-1118.
ELLIOTT B. M., ROBISON J. G., BROTHERS T. E., CROSS M. A. Limitations of peroneal artery bypass grafting for limb salvage. J Vasc Surg, 1993, 18 : 881-888.
ILLIG K., MORAN S., SERLETTI J., OURIEL K., ORLANDO G., SMITH A., SHORTELL C. K., GREEN R. M. Combined free tissue transfer and infrainguinal bypass graft : an alternative to major amputation in selected patients. J Vasc Surg, 2001, 33 : 17-23.
VAN DAMME H., BAGUET E., CREEMERS E., ZHANG L., LIMET R. A continuous series of 90 crural artery revascularisations with the greater saphenous vein. Eur J Vasc Endovasc Surg, 2003, 26 : 635-642.
CUTSON T. M., BONGIORNI D. R. Rehabilitation of the older lower limb amputee : a brief review. J Am Geriatr Soc, 1996, 44 : 1388-1393.
NEHLER M. R., MONETA G. L., EDWARDS J. M., YEAGER R. A., TAYLOR L. M. Jr, PORTER J. M. Surgery for chronic lower extremity ischemia in patients eighty or more years of age : operative results and assessment of postoperative independence. J Vasc Surg, 1993, 38 : 7-14.
DOSSA C. D., SHEPARD A. D., AMOS A. M., KUPIN W. L., REDDY D. J., ELLIOTT J. P., WILCZWSKI J. M., ERNST C. B. Results of lower extremity amputations in patients with end-stage renal disease. J Vasc Surg, 1994, 20 : 14-19.
HAKAIM A. G., GORDON J. K., SCOTT T. E. Early outcome of in situ femorotibial reconstruction among patients with diabetes alone versus diabetes and end-stage renal failure : analysis of 83 limbs. J Vasc Surg, 1998, 27 : 1049-1055.
MEYERSON S. L., SKELLY C. L., CURI M. A., DESAI T. R., KATZ D., BASSIOUNY H. S., MCKINSEY J. F., GEWERTZ B. L., SCHWARTZ L. B. Long-term results justify autogenous infrainguinal bypass grafting in patients with end-stage renal failure. J Vasc Surg, 2001, 34 : 27-33.
RAMDEV P., RAYAN S. S., SHEAHAN M., HAMDAN A. D., LOGERFO F. W., AKBARI C. M., CAMPBELL D. R., POMPOSELLI F. B. Jr. A decade experience with infrainguinal revascularization in a dialysis-dependent patient population. J Vasc Surg, 2002, 36 : 969-974.
WHITTEMORE A. D., DONALDSON M. C., MANNICK J. A. Infrainguinal reconstruction for patients with chronic renal insufficiency. J Vasc Surg, 1993, 17 : 32-39.
SANCHEZ L. A., GOLDSMITH J., RIVERS S. P., PANETTA T. F., WENGERTER K. R., VEITH F. J. Limb salvage surgery in end-stage renal disease : is it worthwhile? J Cardiovasc Surg (Torino), 1992, 33 : 344-348.
CARSTEN C. G. 3rd, TAYLOR S. M., LANGAN E. M. 3rd, CRANE M. M. Factors associated with limb loss despite a patent infrainguinal bypass graft. Am Surg, 1998, 64 : 33-38.
GUZMAN R., ABDOH A., DOWNS A. Measuring functional health status of patients in a vascular surgery clinic setting. Surg Forum, 1996, 47 : 666-667.
HILL A. Patient-oriented outcomes for quality control in vascular surgery. Surg Forum, 1996, 47 : 666-667.
Editorial. Quality of life and clinical trials. Lancet, 1995, 346 : 1-2.
TESTA M. A., SIMONSON D. C. Assesment of quality-of-life outcomes. N Engl J Med, 1996, 334 : 835-840.
GIBBONS G., BURGESS A., GUADAGNOLI E., POMPOSELLI F., FREEMAN D., CAMPBELL D. Return to well-being and function after infrainguinal revascularization. J Vasc Surg, 1995, 21 : 35-45.
THOMPSON M. M., SAYERS R. D., REID A., UNDERWOOD M. J., BELL P. R. Quality-of-life following infragenicular bypass and lower limb amputation. Eur J Vasc Endovasc Surg, 1995, 9 : 310-313.
DUGGAN M. M., WOODSON J., SCOTT T. E., ORTEGA A. N., MENZOIAN J. O. Functional outcomes in limb salvage vascular surgery. Am J Surg, 1994, 168 : 188-191.
SEABROOK G. R., CAMBRIA R. A., FREISCHLAG J. A., TOWNE J. B. Health-related quality-of-life and functional outcome following arterial reconstruction for limb salvage. Cardiovasc Surg, 1999, 7 : 279-286.
BROTHERS T. E., RIOS G. A., ROBISON J. G., ELLIOT B. M. Justification of intervention for limb-threatening ischemia : a surgical decision analysis. Cardiovasc Surg, 1999, 7 : 62-69.
ABOU-ZAMZAM A. M. Jr, LEE R. W., MONETA G. L., TAYLOR L. M. Jr, PORTER J. M. Functional outcome after infrainguinal bypass for limb salvage. J Vasc Surg, 1997, 25 : 287-297.
DORMANDY J., BELCHER G., BROOS P., EIKELBOOM B., LASZLO G., KONRAD P., MOGGI L., MUELLER U. Prospective study of 713 below-knee amputations for ischaemia and the effect of a prostacyclin analogue on healing. Hawaii Study Group. Br J Surg, 1994, 81 : 33-37.
GUPTA S. K., VEITH F. J., ASCER E., FLORES S. A., GLIEDMAN M. L. Cost factors in limb-threatening ischaemia due to infrainguinal arteriosclerosis. Eur J Vasc Surg, 1988, 2 : 151-154.
FISHER S. V., GULLICKSON G. Jr. Energy cost of ambulation in health and disability : a literature review. Arch Phys Med Rehabil, 1978, 59 : 124-133.
CHESHIRE N. J., WOLFE J. H., NOONE M. A., DAVIES L., DRUMMOND M. The economics of femorocrural reconstruction for critical leg ischemia with and without autologous vein. J Vasc Surg, 1992, 15 : 167-175.
RAVIOLA C. A., NICHTER L. S., BAKER J. D., BUSUTTIL R. W., MACHLEDER H. I., MOORE W. S. Cost of treating advanced leg ischemia. Bypass graft vs primary amputation. Arch Surg, 1988, 123 : 495-496.
MALONE J. M., SNYDER M., ANDERSON G., BERNHARD V. M., HOLLOWAY G. A. Jr, BUNT T. J. Prevention of amputation by diabetic education. Am J Surg, 1989, 158 : 520-524.