Role of Aorto(bi)femoral Bypass in Treatment of Patients with Critical Limb Threatening Ischemia

Purpose: To analyse the long-term outcome of open aortic procedures in patients with critical limb threatening ischemia. Methods: Retrospective analysis of all patients with aortoiliac TransAtlantic Inter-Society Consensus II (TASC II), type D (TASC D) lesions extending to the femoral artery who underwent aortic bypass procedures for critical limb threatening ischemia (CLTI) or intermittent claudication (IC). Results: Over a period of 10 years, 87 patients with IC and 45 patients with CLTI received a total of 56 aortounifemoral and 76 aorto-bi-femoral bypass procedures. After 7 years, overall primary patency (82.2% [CLTI] vs. 80.5% [IC], p =.918) and overall secondary patency (88.9% [CLTI] vs. 88.5% [IC], p =.851) were similar between patients with CLTI and those with IC. Long-term-survival (66.7% vs. 71.3%, p =.356) as well as limb salvage (86.7% vs. 94.3%, p =.104) was considerably lower in the CLTI-group, but the difference was not statistically significant. In the subgroup analysis, patients with CLTI and ischemic lesions (Rutherford class 5e6) had the poorest outcome after 84 months, in terms of secondary patency (92.1% vs. 73.7%, p =.015), limb salvage (97.4% vs. 73.7%, p =.000), and long-term survival (75.0% vs. 26.3%, p =.000) compared to patients with IC. Multivariate analysis revealed significant associations for patients with Rutherford class 5e6 in terms of secondary patency (p =.037) and limb salvage (p =.015). There was a significant difference in primary patency between graft limbs with superficial femoral artery occlusion and graft limbs with patent superficial femoral artery (84.6% vs. 93.0%, p =.017). Conclusions: Aortic bypass procedures can be used in the treatment of patients with CLTI. Moreover, results are satisfactory in patients with ischemic rest pain. However, less invasive treatments should be considered for patients with ischemic lesions. (C) 2020 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.