R Suy

Obturator Bypass: a Sixteen Year Experience with 55 Cases

Fifty-five obturator bypasses were performed over a 16 year period for limb salvage. The indications for the choice of this technique included arterial infection, aneurysm formation or soft tissue skin loss at the groin (26 patients), and extensive atherosclerotic disease of the iliofemoral vessels, precluding their use for inflow or outflow (27 patients). There were five perioperative deaths and the five-year patency rate was 37%. Long-term results after above-knee reconstruction substantially exceeded those for below-knee anastomoses (three year patency rates of 71% and 45% respectively). Due to its morbidity and mortality the decision to perform an obturator bypass should be based upon sound indications such as deep infection at the groin, or extensive multilevel arterial disease. Its usefulness in extensive multilevel arterial disease is not demonstrated.

Graft occlusion following aortofemoral Dacron bypass

We report on a series of 930 patients who received an aortobifemoral Dacron graft between 1963 and 1988. The operative mortality was 5.6% and the mean follow-up reached 5.45 years (range one month to 23.6 years). Late occlusion was noted in 125 patients and the primary patency rate decreased to 74% and 69%, respectively at 10 and 15 years. Long-term patency was primarily (p < 0.05) dependent on (1) the date of operation, (2) postoperative smoking habits, (3) distal occlusive disease, and (4) age of the patients at the time of surgery. Vascular reconstruction for late thrombosis was performed for 110 late occlusions in 103 patients. Included were 95 unilateral and 15 bilateral occlusions. The method of choice was graft limb thrombectomy (unilateral occlusion) or anatomical graft replacement (bilateral occlusion or unilateral occlusion when thrombectomy proved to be impossible). Associated outflow reconstructions consisted of profundaplasty in 73.3% of the cases. A mean yearly thrombosis rate of 9.4% (range 4–14%) resulted in a five year patency rate of 59%. Differences between graft thrombectomy and anatomical replacement were not statistically significant. Reconstruction for secondary occlusions was associated with a 25% thrombosis rate. Tertiary occlusion in six cases invariably led to major amputation. A total of 20 patients ultimately needed a major amputation, resulting in an eight year limb salvage rate of 79%.

Clinical trial of Brinase and anticoagulants as a method of treatment for advanced limb ischemia

SummaryA randomized, single-blind trial of repeated intravenous infusion of Brinase was carried out in 70 patients with severe chronic limb ischemia, who were candidates for lumbar sympathectomy or amputation. The enzyme caused a significant increase in calf and ankle pressure index. At six months follow-up, the clinical results were statistically significant in favour of Brinase when all patients were considered, but not if 10 patients with Buergers disease were omitted from the analysis. Patients treated with a combination of Brinase and coumarins had a better clinical outcome than patients receiving either treatment on its own.

The Human Umbilical Vein Graft in Below-Knee Femoropopliteal and Femorotibial Surgery: an Eight Year Experience

The authors present a series of 175 femoropopliteal (below-knee) and 65 femorotibial reconstructions with the human umbilical vein (HUV) graft performed over an eight year period. With a mean follow-up of 36.7 months (range one month to 84 months) the early patency rate of 89% decreased to 54% after five years. Long-term patency was found to be primarily related to the location of the distal anastomosis and the quality of the outflow, showing a statistically significant decrease after repeat revascularization. Early thrombosis, even in the absence of a technical failure and late aneurysmal degeneration remain the major problems associated with the use of the HUV graft. It is therefore recommended that these reconstructions be preserved for patients with advanced ischemia or a limited life-expectancy.