Infra Inguinal Bypass in Single Tibial Vessel Outflow-early outcomes.

Saravanan Robinson, C (2008) Infra Inguinal Bypass in Single Tibial Vessel Outflow-early outcomes. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : In Chronic Limb Ischemia, Infrainguinal bypass surgery is the mainstay of therapeutic interventions aimed at limb salvage. The outcome of surgery is the chief determinant of limb salvage and is affected by many factors. Those factors can be modifiable factors and non modifiable factors. Since 1949, when Kunlin introduced the femoropopliteal bypass graft with saphenous vein, several centers have reported their results. Patency rates at 30 days have varied from 76% to 96%1. Cumulative five-year patency has varied from 60% to 76%1. Patients with limb-threatening arterial ischemia and extensive tibio-peroneal occlusive disease challenge the vascular surgeon. Several reports have documented acceptable patency rates, limb salvage, and operative mortality with arterial bypasses to the ankle and foot. Results are similar to grafts to the tibial and peroneal vessels. In spite of these, the procedures have not gained widespread acceptance. Standard arteriography often does not demonstrate arterial anatomy of the ankle and foot. Operations are tedious and lengthy. Surgical technique must be meticulous. For these reasons, skepticism has prevailed. Major amputation is often offered as a primary mode of therapy. Graft thrombosis in the early postoperative period represents a failure for both patient and surgeon. The causes for the graft failure involve both patient factors and technical factors. It is believed technical errors at the time of operation account for early failures and some cases of late failure in long follow up, and there is general agreement that technical factors account at least for early failures. The patency rates have been related to clinical severity of ischemia, runoff, diabetes and diameter of vein. Some authors report an adverse effect of diabetes on patency whereas others report no adverse effect. Some believe clinical severity of ischemia influences graft failure whereas others believe the severity of ischemia has little to do with patency. Some believe failure is more likely in the present of poor run-off whereas others believe run-off does not affect early patency. Most authors believe small veins are apt to occlude. Graft failure rates of up to 25% have been described and in the graft failure patients more than 50% suffer a major amputation their first year. In general, limb loss in the early post operative period is about 10% and the perioperative mortality rate is 4% in infrainguinal bypass surgery. AIM : To assess early postoperative outcomes in patients undergoing Infrainguinal bypass surgery with Single Tibial artery outflow and to study the factors affecting outcome. CONCLUSION : Infrainguinal bypass with single tibial vessel outflow yields acceptable patency and survival rates. Patients with poor conduit quality, active tobacco use and LV dysfunction have poorer clinical outcome. In patients with single vessel runoff, the angiographic runoff score does not affect early outcome. – It is however a marker for subsequent limb loss. – It should not preclude aggressive attempts at limb salvage in selected patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Infra Inguinal Bypass ; Single Tibial Vessel Outflow ; early outcomes.
Subjects: MEDICAL > Vascular Surgery
Depositing User: Kambaraman B
Date Deposited: 24 Jul 2017 02:30
Last Modified: 24 Jul 2017 02:30

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