Abstract
We conducted a midterm follow-up of 150 claudicants who underwent surgical reconstruction by assessing cumulative patency, survival, and palliation (graft patency in live patients) rates. Eighty-nine claudicants (group I) underwent direct (in situ) proximal revascularization, 33 (group II) had indirect (ex situ) proximal revascularization, while 28 (group III) had distal revascularization. The secondary patency rates at 3 years were 97.5% in group I, 97.0% in group II, and 75.0% in group III, respectively. Only one patient with limb graft thrombosis required below-knee amputation. There were 3 perioperative deaths (2 in group I and 1 in group II). The survival rates at 3 years were 86.0% in group I, 69.5% in group II, and 95.8% in group III, respectively. The palliation rates at 3 years were 84.8% in group I, 70.0% in group II, and 77.9% in group III, respectively. These findings indicate the midterm benefits of supra- and infrainguinal arterial reconstructions, and also suggest that the preoperative assessment of risks in individual patients, the selection of the appropriate operative procedure and graft material, and intensive postoperative follow-up and management of any associated disease are all important aspects in the treatment of claudicants.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bloor K (1961) Natural history of atherosclerosis of the lower extremities. Ann R Coll Surg Engl 28:36–51
Dormandy J, Mahir M, Ascady G, Balsano F, De Leeuw P, Blembery P (1989) Fate of patients with chronic leg ischemia. J Cardiovasc Surg 30:50–57
Ohta T, Kato Y, Kazui H, Kondo M, Tsuchioka H, Shionoya S (1989) The prognosis of intermittent claudication. J Jpn Surg Soc 90:615–621
Sladen JG, Gilmour JL (1985) Fate of claudicant after femoropopliteal vein bypass: Prospective, long-term follow-up of 100 patients. Can J Surg 28:401–404
The Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery (1986) Suggested standard for reports dealing with lower-extremity ischemia. Prepared by the ad hoc committee on reporting standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 4:80–94
Martines BD, Hertzer NR, Beven EG (1980) Influence of distal arterial occlusion on prognosis following aortobifemoral bypass. Surgery 88:795–805
Jones AF, Kempczinski RF (1981) Aortofemoral bypass grafting. A reappraisal. Arch Surg 116:301–305
Szilagyi DE, Elliot JP Jr, Smith RF, Reddy DJ, McPharlin M (1986) A thirty-year survey of the reconstructive surgical treatment of aortoiliac occlusive disease. J Vasc Surg 3:421–436
Sladen JG, Gilmour JL, Wong RW (1986) Cumulative patency and actual palliation in patients with claudication after aortofemoral bypass. Prospective long-term follow-up of 100 patients. Am J Surg 152:190–195
Piotrowski JJ, Pearce WH, Jones DN, Whitehill T, Bell R, Patt A, Rutherford RB (1988) Aortofemoral bypass: Operation of choice for unilateral iliac occlusion? J Vasc Surg 8:211–218
Plecha PR, Plecha FM (1984) Femorofemoral bypass grafts: Ten-year experience. J Vasc Surg 1:555–561
Kalman PG, Hosang M, Johnston KW, Walker PM (1987) The current role for femorofemoral bypass. J Vasc Surg 6:71–76
Broome A, Christenson JT, Eklof B, Norgren L (1980) Axillofemoral bypass reconstruction in 61 patients with leg ischemia. Surgery 88:673–676
Donaldson MC, Louras JC, Bucknam CA (1986) Axillofemoral bypass: A tool with a limited role. J Vasc Surg 3:757–763
Schultz GA, Sauvage LR, Mathisen SR, Mansfield PB, Smith JC, Davis CC, Hall DG, Rittenhouse EA, Kowalsky TE (1986) A five-to seven-year experience with externally supported Dacron protheses in axillo-femoral and femoropopliteal bypass. Ann Vasc Surg 1:214–223
Rutherford RB, Patt A, Pearce WH (1987) Extra-anatomic bypass: A closer view. J Vasc Surg 6:437–446
Harris EJ Jr, Taylor LM Jr, McConnell DB, Moneta GL, Yeager RA, Porter JM (1990) Clinical results of axillobifemoral bypass using externally supported polytetra-fluoroethylene. J Vasc Surg 12:416–421
Kalman PG, Hosang M, Cina C, Ameli FM, Walker PM, Provan JL (1987) Current indications for axillounifemoral and axillobifemoral bypass graft. J Vasc Surg 5:828–832
Leather RP, Shah DM, Chang BB, Kaufman JL (1988) Reconstruction of the in situ saphenous vein bypass: 1,000 cases later. Ann Surg 208:435–442
Kent KC, Donaldson MC, Attinger CE, Couch NP, Mannick JA, Whittemore AD (1988) Femoro-popliteal reconstruction for claudication. The risk to life and limb. Arch Surg 123:1196–1198
Kato R, Kazui H, Ohta T, Tsuchioka H (1989) A comparison of EXS graft and autogenous vein: The long-term results of femoropopliteal and femorotibial bypass (in Japanese). Jpn J Cardiovasc Surg 19:382–385
Taylor LM, Edward JM, Porter JM (1990) Present status of reversed vein bypass grafting: Five-year results of a modern series. J Vasc Surg 11:193–206
Rosenthal D, Evans RD, Mckinsey J, Seagraves MA, Lamis PA, Clark MD, Daniel WW (1990) Prosthetic above-knee femoropopliteal bypass for intermittent claudication. J Cardiovasc Surg 31:462–468
Matsubara J, Nagasue M, Tsuchishima S, Nagatani B, Shimizu T (1990) Clinical results of femoropopliteal bypass using externally supported (EXS) Dacron grafts: With a comparison of above- and below-knee anastomosis. J Cardiovasc Surg 31:731–734
Bunt TJ (1986) Aortic reconstruction vs extra-anatomic bypass and angioplasty. Thoughts on evolving a protocol for selection. Arch Surg 121:1166–1171
Hertzer NR, Beven EG, Young JR, O'Hara PJ, Ruschhaupt WF 3rd, Graor RA, Dewolfe VG, Maljovec LC (1984) Coronary artery disease in peripheral vascular patients: A classification of 1,000 coronary angiograms and results of surgical management. Ann Surg 199:223–233
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ohta, T., Kato, R., Sugimoto, I. et al. Benefits of arterial reconstruction in claudication. Surg Today 25, 891–896 (1995). https://doi.org/10.1007/BF00311754
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00311754