Current Status of Lower Extremity Bypass Grafts

Abstract

MATERIAL AND METHODS:
This study consisted of 113 patients who underwent 121 lower limb revascularization operations by the author between September 1979 and December, 1983. Patient population consisted of 65.men and 48 women, ranging in age from 33-93 years (mean 67.2 years). Seventy- eight were Caucasian and 35 black. Atherosclerotic heart disease (63 patients), hypertension (56 patients), diabetes melitis (47 patients) and cerebrovascular disease (20 patients) were present. Two-thirds of the populations were smokers. All data were entered into a computer and frequency tables were generated. Chi square analysis with Yates correction was used for statistical computation and cumulative patency curves were generated using standard life table analysis.

RESULTS:
One hundred twenty-one lower extremity bypasses were attempted in 113 patients. Sync hronous procedures included proximal revascularization (10), lumbar sympathectomy (14) and minor or major amputations (11). Three deaths (2.6%) occurred within thirty days, two of myocardial infarctions and one of bilateral cerebral infarction Post-operative complications in dud ed cardiac (8), in cisional (9), cerebrovasc ul ar (3) and miscellaneous (6) events. One patent but infected graft required removal. Eighteen late deaths occurred during follow up, the majority from cardiac events.

DISCUSSION:

Nonoperative therapy is adequate in the majority of patients with lower extremity occlusive vascular disease, consisting of a no smoking and graduated exercise walking program. Pentoxyfylline, a cylinc AMP inhibitor is one of• a,, new generation of drugs that shows promise in the relief of claudication symptoms. The late mortality continues to be high due to the sequelae of generalized atherosclerotic disease, especially myocardial ischemia. The five year patency rates with AV vary from 60-75% depending on the indication for operation.5 Long term results are worse when the indication is impending limb loss rather than claudicating.