Management of graft occlusion in infrainguinal bypass surgery in chronic lower limb ischemia

Management of graft occlusion in infrainguinal bypass surgery in chronic lower limb ischemiaOsama M. Megahed MD, Ibrahem M. Mostafa MD, Ayman A. Salem MD, Mohamed A. Efat MD and Ahmad M. Tawfik MSc.Zagazig university, Faculty of medicine, General surgery department.Objectives: To evaluate the different methods of diagnosis and management of graft occlusion either early or late in our department.Methods: Over the period from September 2007 to September 2009, 30 patients with graft occlusion either early in group A (<30 days) or late in group B (>30 days) were presented to us by manifestation of critical lower limb ischemia. Multiple re-do procedures were done to these patients included new bypass, thrombectomies, endartrectomies with patch angioplasties. The choice of the procedure depend on the time of the occlusion, the primary procedure, the general condition of the patient and the condition of the patient’s arterial tree.Results: In group A the patency rates were 62% and 78% for primary and secondary patency rate respectively with limb salvage rate at one month 85%. In group B the patency rates were 86% and 100% for primary and secondary patency rate respectively with limb salvage rate was 100% at one month. As regard the results at one year the primary patency rate in group A was 47% and the secondary patency was 65% with limb salvage rate 54%. In group B the primary patency rate was 39% and the secondary patency rate was 56% with limb salvage rate was 63%.Conclusions: Vascular surgeons must maintain an aggressive attitude toward these secondary procedures when a primary procedure fails to achieve or maintain its intended goal and when a patient is faced with the imminent loss of a lower limb because of distal ischemia. Intervention must be done once failing graft was detected as the result of the re-do surgery in the failed graft is not good.Keywords: occluded graft- failed bypass-re do surgery- secondary procedure.