Comparable Limb Salvage Outcomes on Pop Distal Bypass when Using Plantar Artery as a Distal Target.

Abstract

Objective: The primary objective is to describe limb salvage and patency rates of infra-genicular bypasses using plantar artery as a distal target. The secondary objective is to compare outcomes between bypasses to the plantar artery and those to other tibial arteries.

Methods: Retrospective cohort study of all consecutive patients who underwent infra-genicular bypasses using autologous venous conduit from July 2012 to June 2018. Demographic variables, indications for surgery, limb salvage, and bypass patency were recorded, and statistical analysis was performed. Exclusion criteria were inflow vessels above the knee, acute limb ischemia, and use of synthetic conduits.

Results: Ninety procedures were performed from the third portion of the popliteal artery (POP) to either the anterior tibial (AT), dorsalis pedis (DP), posterior tibial (PT), peroneal (Per), or plantar artery (plantar). The mean age was 70 years old, with 50 patient's male (56%). Predominant comorbidities were diabetes mellitus (87.8%), hypertension (94.4%), and active smoking (25%). Indications for surgery were gangrene (63%), followed by ulceration (26%) and rest pain (11%). There were forty-one Pop-DP (45.5%), twenty-three Pop-Plantar (25.6%), twenty Pop-PT (22.2%), four Pop-Peroneal (4.4%), and two Pop-AT (2.2%). The median follow-up time was 65 months. The limb salvage at one year for plantar artery bypass was 65% (17 patients) and 82% (58 patients) for all other distal bypasses. Kaplan-Meier analyses showed 1-year patency of 65% for plantar bypass while 82% for all other distal bypasses while 3-year patency rates dropped to 60% and 75%, respectively (P=0.185, Chi-square 1.75).

Conclusion: The plantar artery as a target vessel for infra-genicular bypass using autologous vein conduit is an effective surgical option with acceptable limb salvage and patency rates.