Predictive factors for adverse outcome of pedal bypasses

Objective: to identify the risk factors affecting the outcome of bypass grafts to the foot arteries. Design: longitudinal observational study from a single institution. Materials and methods: one-hundred and sixty-five infrainguinal bypasses to the foot arteries were performed in 162 legs of 149 patients with critical leg ischaemia. Results: at 1-month, 1-year, 2-year and 3-year follow-up, the primary patency rates were 74%, 43%, 38% and 34%, the secondary patency rates were 82%, 50%, 47% and 41%, the leg salvage rates were 88%, 66%, 66% and 60%, survival rates were 95%, 76%, 69% and 55%, whereas 82%, 53%, 49% and 36% of patients were alive with salvaged leg, respectively. Low preoperative plasma concentrations of C-reactive protein (CRP) and short grafts with more distal arterial inflow had a better outcome. Better primary and secondary patency rates were also achieved by experienced surgeons and by the use of in situ saphenous vein grafts. Pedal run-off scoring did not have any impact on the outcome of pedal bypasses. Conclusions: short pedal bypasses using in situ saphenous vein technique, done by an experienced surgeon, have the best outcome. Revascularisation to the foot arteries may carry a poor outcome in patients with elevated preoperative CRP concentration.