Popliteal-to-Distal Extreme Bypass in Endovascular Era

Chiara Barillà; Narayana Pipitò; Domenico Squillaci; Federica Maria Castellana; Alessandra Fittipaldi; Giovanni De Caridi; Filippo Benedetto

doi:10.1016/j.avsg.2024.02.005

Popliteal-to-Distal Extreme Bypass in Endovascular Era

Ann Vasc Surg. 2024 Apr 6:104:276-281. doi: 10.1016/j.avsg.2024.02.005. Online ahead of print.

Authors

Chiara Barillà¹, Narayana Pipitò¹, Domenico Squillaci¹, Federica Maria Castellana¹, Alessandra Fittipaldi², Giovanni De Caridi¹, Filippo Benedetto¹

Affiliations

¹ Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy.
² Vascular Surgery Unit, Department of Medical Sciences and Morpho-Functional Imaging - University of Messina, Messina, Italy. Electronic address: alessandra_fittipaldi@yahoo.it.

PMID: 38588950
DOI: 10.1016/j.avsg.2024.02.005

Abstract

Background: Chronic limb-threatening ischemia (CLTI) is characterized by rest pain and tissue loss, with an annual mortality rate of 20% and amputation rate of 40%, if not treated. Open bypass surgery is recommended in CLTI, depending on the availability of good quality venous material, outflow artery patency, and surgical expertise. The aim of the study is to analyze primary patency, limb salvage, and survival rate in patients undergoing popliteal-to-distal bypass.

Methods: All consecutive patients who underwent popliteal-to-distal bypass surgery between January 2016 and December 2021 were enrolled in the study. Primary outcomes were primary patency, limb salvage, and overall survival. Secondary outcomes included amputation-free survival and secondary patency.

Results: Forty-nine patients were included during the study. Technical success was achieved in 100% of cases. Target outflow artery was in 27% (n. 13) of cases the anterior tibial artery, in 27% (n. 13) the dorsalis pedis, in 2% (n. 1) the peroneal artery, in 30% (n. 15) the retromalleolar tibial artery, in 10% (n. 5) the medial plantar artery, and in 4% (n. 2) the tarsal artery. Two-year primary patency was 85% ± 5. Secondary patency rates were 86% ± 3 at 2 years. The overall survival was 81% ± 6 at 2 years, the amputation-free survival was 70% ± 9, and the limb salvage rate was 81% ± 6.

Conclusions: Popliteal-to-distal bypass requires high technical expertise to be performed. When a good autologous vein and adequate outflow artery are present, they can be feasible with good patency rates and overall survival.