Diagnostics (Mar 2023)

Long-Term Results of Below-The-Knee Bypass Using a Prosthetic Graft with a Distal Arteriovenous Fistula Interposition

  • Francesco Spinelli,
  • Giuseppe Roscitano,
  • David Barillà,
  • Graziana Derone,
  • Antonio Nenna,
  • Nunzio Montelione,
  • Vincenzo Catanese,
  • Andrea Cutrupi,
  • Martina Maria Giambra,
  • Alessandra Varrà,
  • Pier Francesco Veroux,
  • Francesco Stilo

DOI
https://doi.org/10.3390/diagnostics13071246
Journal volume & issue
Vol. 13, no. 7
p. 1246

Abstract

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Surgical bypass is the gold standard treatment in patients affected by chronic limb-threatening ischemia in advanced GLASS stages, according to the Global Vascular Guidelines. For patients in whom an autologous graft is not available, a prosthesis could be used with the adjunct of a distal arteriovenous fistula interposition. The aim of this study was to examine the long-term results of below-the-knee surgical revascularization using a prosthesis with the distal adjunct mentioned above. From 2010 to 2020, we performed 159 lower limb below-the-knee surgical revascularizations using a prosthesis with the creation of an arteriovenous fistula interposition on the distal anastomosis. The GLASS stage was 3 in 100% of patients. The primary patency rates were as follows: 86.7% at 1 year, 57.2% at 3 years, and 12.6% at 5 years. The graft thrombosis rates were 17.4% at 1 year, 42.1% at 3 years, and 64.5% at 5 years. The amputation-free survival rates were 79% at 1 year, 76% at 3 years, and 64% at 5 years. PTFE prosthetic bypass for below-the-knee arteries using an arteriovenous fistula interposition is a good solution in patients without an autologous conduit. This technique offers reasonable graft patency and limb salvage rates.

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