Results of pedal bypass surgery for critical limb ischemia

Abstract

The incidence of critical limb ischemia is estimated to be about 500–1000 per 1 million population in Western Europe. Today, 25 % of patients are treated conservatively including PTA-techniques, 25 % have primary amputation, and 50 % receive arterial reconstruction (1, 22). Particularly limbs with infrapopliteal occlusive disease in the preoperative angiogram are frequently considered unreconstructible. Perioperative mortality after major amputation is about 10 % and the prognosis is also poor in those patients who cannot walk with a prosthesis and are confined to bed or a wheelchair (12). In the last decade the lower limit of distal revascularization has been further extended to the arteries of the ankle and the foot and several reports documented long-term patency- and limb salvage-rates between 60 and 90 %, even in diabetics and multimorbid patients (2–4, 8, 9, 11, 14, 15, 21, 23, 24, 26–29). In addition, it has been shown that femoro-distal revascularization to the foot vessels decreases the number of major lower limb amputation in 25 to 50 %. These number, however, have been achieved in few hospitals and still await validation in nationwide or large area statistics (13, 14, 17, 25).