Objective
This study evaluated the outcome of combined popliteal-to-distal bypass and angioplasty of inflow lesions in patients with critical limb ischemia (CLI).
Patients and methods
Data of all patients with CLI undergoing infrapopliteal bypasses with inflow originating from the popliteal artery above the knee (Pop-AK) or below the knee (Pop-BK) were analyzed retrospectively. Outcomes assessed were patency rates, amputation-free survival, patient survival, and wound healing rates at 1-year follow-up. A comparative analysis of patency rates and amputation-free survival between Pop-AK and Pop-BK bypasses was done.
Results
A total of 43 bypasses originating from the popliteal artery (19 Pop-AK and 24 Pop-BK) were performed in the period from March 2017 to February 2021 at Vascular Surgery Department, Zagazig University Hospitals, Egypt. Overall, 25 patients necessitated preoperative endovascular treatment of femoropopliteal lesions, where 18 were males, mean age was 72.8 ± 10 years, diabetes mellitus was seen in 88%, hypertension was seen in 80%, and renal impairment was seen in 36%. The Trans-Atlantic Inter-Society Consensus II (TASC II) classification of femoropopliteal lesions was TASC II-B in 21 (84%) patients, TASC II-C in two (8%) patients, and TASC II-D in two (8%) patients. A total of 13 (52%) distal bypasses originated from Pop-AK and 12 (48%) from Pop-BK. The most common outflow artery was the anterior tibial artery (60%). At 1-year follow-up, the primary patency rate was 48%, the assisted-primary patency rate was 84%, and the secondary patency rate was 96%. At 12 months, amputation-free survival and patient survival rates were 100 and 88%, respectively. Wound healing at 12 months reached 96%.
Conclusion
Combined popliteodistal bypass with inflow arterial angioplasty is a useful therapeutic option in treating patients with CLI because of durable patency, acceptable wound healing rates, and good limb salvage. This hybrid approach provides a good solution in cases of combined femoropopliteal lesions with limited autogenous conduit.