Objective: This study is evaluating the effectiveness of salvage interventions to rescue threatened infra-popliteal (IP) bypasses in critical limb ischemia (CLI) patients.
Materials and methods: Data of all CLI patients who underwent distal IP bypasses at a single institution between 2016 and 2021 are analysed retrospectively. Patency rates, amputation-free survival, patient survival, and wound healing rates after a 1-year follow-up period are calculated. Comparative analyses of amputation free survival and patient survival rates between non-threatened, threatened and acutely occluded grafts are also done.
Results: A total of 121 IP bypasses were performed in 115 patients (84 male; mean age, 74.4±8; hypertension, 84%; diabetes mellitus, 69%). 24% originated from the common femoral artery, 40% from the superficial femoral artery and 36% from the popliteal artery. The most common outflow arteries are the anterior tibial artery (36%) and the posterior tibial artery (33%). Secondary interventions in the form of endovascular and surgical revisions are necessitated in 53 (44%) grafts.
At one-year follow-up, primary, assisted-primary, and secondary patency rates are 50%, 78% and 88%, respectively.
Amputation-free survival and patient survival rates are 93% and 86%, respectively. Complete wound healing rate is 83%. Amputation-free survival among acutely occluded grafts is significantly worse when compared with threatened and non-threatened grafts (P-value<0.001). 
Conclusion: Secondary interventions to rescue threatened distal bypasses are successful at maintaining graft patency with amputation-free survival rate comparable to non-threatened grafts. Salvage angioplasty is a viable alternative to surgical revision to rescue limbs with threatened grafts in CLI patients.