Impact of foot arch status on the outcome of infra-popliteal bypasses in critical limb ischemia patients with tissue loss

Abstract

Objective This study evaluates the effect of arterial pedal arch quality on patency rates, freedom from major amputation, and wound healing in patients with critical limb ischemia (CLI) with tissue loss undergoing distal bypasses. Materials and methods A retrospective analysis of prospectively collected data of all patients with CLI with tissue loss who underwent distal bypass between 2017 and 2021 at a single institution was done. Post-bypass pedal angiography was performed to classify patients according to the foot arch status into three groups: complete pedal arch (CPA), incomplete pedal arch (IPA), and no pedal arch (NPA). Patency, amputation-free survival, patient survival, and wound healing rates are assessed at 1-year follow-up and compared among the three groups. Results A total of 88 patients had infrapopliteal bypasses (62 male; mean age, 74±9; hypertension, 85%; diabetes mellitus, 76%; smoking, 78%; and dyslipidemia, 71%). Overall, 49% of the distal bypasses originated from the popliteal artery, 31% from the superficial femoral artery, and 20% from the common femoral artery. The most common outflow artery was the anterior tibial artery (39%) followed by the posterior tibial artery (36%). At 1-year follow-up, primary patency rates in the CPA, IPA, and NPA groups were 62, 53, and 45%, respectively (P=0.41). Assisted primary patency rates were 91, 76, and 83%, respectively (P=0.424). Secondary patency rates are 100, 88, and 83%, respectively (P=0.193). Overall patient survival at the end of the follow-up period was 81%. There was a statistically significant difference in terms of 12-month amputation-free survival among the three groups (CPA 100% vs. IPA 98% vs. NPA 83%, P=0.015). Moreover, a statistically significant difference existed in wound healing rates between the study groups (CPA 81% vs. IPA 90% vs. NPA 61%, P=0.039). Conclusion Pedal arch status has a positive effect on major amputation-free survival and wound healing in patients with CLI with foot wounds undergoing infrapopliteal bypass grafting.