RETROSPECTIVE ANALYSIS OF INFRAPOPLITEAL BYPASS PROCEDURES :3 YEARS INSTITUTIONAL EXPERIENCE

OBJECTIVE: The purpose of this study is to evaluate the patency rate and limb salvage of patients with critical limb ischemia who have undergone infrapopliteal bypass. METHODOLOGY: A retrospective analysis of all patients who have undergone infrapopliteal bypasses in the past 3 years with either autogenous vein or synthetic graft with inflow from CFA,SFA or popliteal for critical limb ischemia was done.Primary outcomes were primary patency and limb salvage at 1 year. .A subgroup analysis included comparison of patency between the bypasses with CFA,SFA and popliteal as inflow was done. All patients were subjected to pulse examination, ABI measurement and duplex surveillance at 1 year. RESULTS: A total of 79 patients have undergone infrapopliteal bypasses in the past 3years.It included 71 men and 8 women.The mean age was 50.1.Apart from one case,autogenous vein was used as conduit.Bypass grafts originated from common femoral artery in 45 cases,superficial femoral artery in 22 cases and popliteal artery in 12 cases.Distal anastomosis was done to TP trunk in 16 cases,anterior tibial artery in 16 cases,posterior tibial artery in 38 cases,peroneal artery in 8 cases and to dorsalis pedis artery in 1 case.In 8 cases, graft thrombosed on the same day of surgery.During the follow up period, 9 patients expired and 17 of them lost follow up.Cumulative primary patency rate was 66% .Limb salvage percentage was 94.3% .It was also found that inflow artery whether it is CFA,SFA or popliteal does not affects the patency of the graft. CONCLUSION: Although the number of bypass surgeries for critical limb ischemia decreases in the last few years,it remains the best treatment modality among the all revascularisation procedures for the infra inguinal disease with respect to limb salvage and patency rates. Infragenicular bypasses that originate from the distal superficial femoral artery or the popliteal artery can be performed with patency and limb salvage rates comparable to bypasses originating from common femoral artery. Importance follow up after revascularization procedures should be educated among the patients,because graft surveillance is important to assess and maintain the patency of these procedures