TY - JOUR
T1 - Functional Failure of Patent Femorodistal In Situ Grafts
AU - Fowl, Richard J.
AU - Patterson, Robert B.
AU - Bodenham, Rosalie J.
AU - Kempczinski, Richard F.
PY - 1989
Y1 - 1989
N2 - We have treated several patients who required major, proximal extremity amputations despite a patent infrainguinal in situ saphenous vein bypass graft. To determine those factors predisposing to such paradoxical limb loss, we studied a group of 45 patients who underwent 48 in situ, femorodistal bypass grafts for tissue necrosis and who maintained a patent graft throughout the perioperative period. Within this cohort, we compared two distinct subgroups: Group I, whose limbs (n = 8) ultimately required a major proximal amputation; Group II, whose limbs (n = 40) emerged with a viable foot and did not require a major amputation. There was no significant difference in the incidence of diabetes, renal failure, smoking, or postoperative ankle/brachial index between the two groups. The presence of gangrene (88% vs 45%), invasive sepsis (63% vs 23%), and combined gangrene and sepsis (63% vs 18%) was significantly (p < 0.05) more prevalent in Group I versus Group II. Forty-three percent of patients with both gangrene and foot sepsis required a major proximal amputation despite a patent graft. Such patients are at high risk for limb loss even if they undergo successful revascularization.
AB - We have treated several patients who required major, proximal extremity amputations despite a patent infrainguinal in situ saphenous vein bypass graft. To determine those factors predisposing to such paradoxical limb loss, we studied a group of 45 patients who underwent 48 in situ, femorodistal bypass grafts for tissue necrosis and who maintained a patent graft throughout the perioperative period. Within this cohort, we compared two distinct subgroups: Group I, whose limbs (n = 8) ultimately required a major proximal amputation; Group II, whose limbs (n = 40) emerged with a viable foot and did not require a major amputation. There was no significant difference in the incidence of diabetes, renal failure, smoking, or postoperative ankle/brachial index between the two groups. The presence of gangrene (88% vs 45%), invasive sepsis (63% vs 23%), and combined gangrene and sepsis (63% vs 18%) was significantly (p < 0.05) more prevalent in Group I versus Group II. Forty-three percent of patients with both gangrene and foot sepsis required a major proximal amputation despite a patent graft. Such patients are at high risk for limb loss even if they undergo successful revascularization.
KW - Femorodistal bypass grafts
KW - grafts
KW - saphenous vein grafts
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U2 - 10.1016/S0890-5096(07)60023-5
DO - 10.1016/S0890-5096(07)60023-5
M3 - Article
C2 - 2775632
AN - SCOPUS:0024696376
SN - 0890-5096
VL - 3
SP - 200
EP - 204
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
IS - 3
ER -