Aortobifemoral bypass for the critically ischaemic limb--is it worth while?
Madiba, T.E.; Robbs, J.V.
South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie 29(4): 138-141
1991
ISSN/ISBN: 0038-2361 PMID: 1763391 Document Number: 379472
Little is written of the place of aortobifemoral bypass as a limb or below-knee-level amputation stump salvage procedure in patients presenting with critical ischaemia with threat of limb loss. Over a 4-year period 151 patients referred to the Vascular Service of the University of Natal Hospitals with aorto-iliac occlusive disease and a threatened limb were studied. All were submitted to aortobifemoral bypass. Patients were divided into two subgroups: group 1 patients presented with rest pain or focal necrosis and were submitted to aortobifemoral bypass with concomitant digital or transmetatarsal amputation; and group 2 patients were submitted to a guillotine-type below-knee amputation in view of ascending infection or extended necrosis that made below-knee amputation impracticable. The objective was to obtain healing of the stump at the below-knee level. Early results within 1 month of operation were as follows: 5 patients (3.3%) died of myocardial infarction. There was no graft sepsis, and groin wound sepsis occurred in 7 (4.5%). Of the group 1 patients 8 required major amputation (8.2%). Three patients in group 2 required proximal above-knee revision (14.3%). The overall limb or stump salvage rate within 1 month of surgery was 89.4%. It was possible to follow up 105 patients in group 1 and 18 in group 2 for between 2 years and 5 years. In group 1, 2.9% required major proximal amputation and 3.8% a subsequent femoral-to-distal bypass. In group 2 none required subsequent major proximal amputation. Overall in those available for long-term follow-up 97% retained the use of a salvaged limb or stump.