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Trends in Medical Research
  Year: 2014 | Volume: 9 | Issue: 1 | Page No.: 1-16
DOI: 10.3923/tmr.2014.1.16
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Factors Affecting Outcome of Infrainguinal Femoropopliteal Bypass in Critical Chronic Lower Limb Ischemia

Khaled M. Attia

This prospective trial conducted on 50 patients who underwent infrainguinal femoropopliteal reconstruction as a definitive treatment of critical chronic lower limb ischemia using either great saphenous vein graft, or polytetrafluoroethylene (PTFE) graft. The clinical outcome of graft patency was assessed in relation to graft infection and risk factors which include: female gender, smoking, the American Society of Anesthesiologists (ASA) grade, diabetes mellitus, hypertension, hyperlipidemia, and obesity. Patients were followed up for a median of 18 months. The outcome of surgery (relieve of rest pain, healing of ischemic ulcers, and patency of the graft) was recorded as well as morbidity and mortality. There were thirty two saphenous vein reconstruction and eighteen PTFE grafts. Thirty days and 3 years mortality were one and 6 respectively. Five cases underwent graft removal and another graft reconstruction. Three patients underwent graft excision but no reconstruction with limb survival in 2 cases and amputation in one case. One patient needed angioplasty. Surgical site infection was diagnosed in 5 patients (10%). The three excised grafts were contaminated with Staphylococcus aureus in two cases and Staphylococcus epidermidis in one case. Enterobacteriaceae was cultured either alone or in combination with Staphylococcus epidermidis in two cases. In one case, the bacterial culture was negative. Females had significantly reduced graft patency rates compared with their male counterparts (p≤0.02) and high ASA grade (III, IV) was predictor of graft failure (p≤0.04). Among the demographic and operative factors which can predict graft failure, the most important are female gender, the presence of critical ischemia at time of primary surgery, the occurrence of a post-operative complication and high ASA grade. A pre-operative history of smoking was not shown to adversely affect long-term graft patency. These data may be of benefit in pre-operative patient selection, patient counseling and ensuring close patient follow-up.
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How to cite this article:

Khaled M. Attia , 2014. Factors Affecting Outcome of Infrainguinal Femoropopliteal Bypass in Critical Chronic Lower Limb Ischemia. Trends in Medical Research, 9: 1-16.

DOI: 10.3923/tmr.2014.1.16






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