Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft.
Introduction: Peripheral arterial disease has become a worldwide problem, with chronic limb-threatening ischemia(CLTI) being its most extreme manifestation. Recently, endovascular strategies evolved and became the first approach in many revascularization procedures. However, infrapopliteal (IP) dis...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | Portuguese |
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Sociedade Portuguesa de Angiologia e Cirurgia Vascular
2023-11-01
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| Series: | Angiologia e Cirurgia Vascular |
| Subjects: | |
| Online Access: | https://acvjournal.com/index.php/acv/article/view/574 |
| _version_ | 1797454167450583040 |
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| author | Armanda Duarte Tony R. Soares Gonçalo Cabral Tiago Costa José Tiago José Gimenez Diogo Cunha e Sá |
| author_facet | Armanda Duarte Tony R. Soares Gonçalo Cabral Tiago Costa José Tiago José Gimenez Diogo Cunha e Sá |
| author_sort | Armanda Duarte |
| collection | DOAJ |
| description |
Introduction: Peripheral arterial disease has become a worldwide problem, with chronic limb-threatening ischemia(CLTI) being its most extreme manifestation. Recently, endovascular strategies evolved and became the first approach in many revascularization procedures. However, infrapopliteal (IP) disease is still a therapeutic challange.1–3
This study aims to present a surgical technique, named inverted T bypass, that can be applied to patients with: an IP artery with poor collateralization to the foot, an inframalleolar artery with poor runoff and availability of only a short venous graft.4
Methods: A single-center retrospective analysis of all patients submitted to inverted T bypass. The end points of the present study were limb-based patency(LBP), primary patency(PP) and secondary patency(SP) rates, freedom from CLTI, recurrence of CLTI, freedom from major index limb amputation, amputation free-survival, and overall survival.
Results: A total of twenty-five patients with CLTI (68% male) with a median age of 77 years were submitted to 25 inverted T bypasses. The median follow-up was 25 months(interquartile range of 32). Twenty-one preoperative angiographies were performed. Severe femoropopliteal (FP) and IP anatomic patterns(GLASS FP and IP grade 4) were predominant(57% and 86%, respectively) with 100% of limbs classified as GLASS stage III. Three patients(12%) had previously failed endovascular treatment. LBP, PP and SP were, respectively, 75%, 75% and 79% at 1 year, and 61%, 61% and 64% at 2 years. After one year, 86% of the limbs were free from CLTI and 79% of them remained without recurrences during a follow-up of 2 years. Eighty-one percent of the patients were free from major index limb amputation at 2 years.
Conclusion: The inverted T bypass is a creative surgical solution for CLTI patients with poor runoff and lacking an adequate venous graft. The results are promising, rendering this technique a viable option for distal and ultra-distal revascularization in complex cases.
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| first_indexed | 2024-03-09T15:34:14Z |
| format | Article |
| id | doaj.art-a1c69b2aea694f15a1ab4d23cda2aff4 |
| institution | Directory Open Access Journal |
| issn | 1646-706X 2183-0096 |
| language | Portuguese |
| last_indexed | 2024-03-09T15:34:14Z |
| publishDate | 2023-11-01 |
| publisher | Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
| record_format | Article |
| series | Angiologia e Cirurgia Vascular |
| spelling | doaj.art-a1c69b2aea694f15a1ab4d23cda2aff42023-11-26T10:48:16ZporSociedade Portuguesa de Angiologia e Cirurgia VascularAngiologia e Cirurgia Vascular1646-706X2183-00962023-11-0119310.48750/acv.574Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft.Armanda Duarte0Tony R. Soares1Gonçalo Cabral2Tiago Costa3José Tiago4José Gimenez5Diogo Cunha e Sá6Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, PortugalDepartment of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, PortugalDepartment of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, PortugalDepartment of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, PortugalDepartment of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, PortugalDepartment of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, PortugalDepartment of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, Portugal Introduction: Peripheral arterial disease has become a worldwide problem, with chronic limb-threatening ischemia(CLTI) being its most extreme manifestation. Recently, endovascular strategies evolved and became the first approach in many revascularization procedures. However, infrapopliteal (IP) disease is still a therapeutic challange.1–3 This study aims to present a surgical technique, named inverted T bypass, that can be applied to patients with: an IP artery with poor collateralization to the foot, an inframalleolar artery with poor runoff and availability of only a short venous graft.4 Methods: A single-center retrospective analysis of all patients submitted to inverted T bypass. The end points of the present study were limb-based patency(LBP), primary patency(PP) and secondary patency(SP) rates, freedom from CLTI, recurrence of CLTI, freedom from major index limb amputation, amputation free-survival, and overall survival. Results: A total of twenty-five patients with CLTI (68% male) with a median age of 77 years were submitted to 25 inverted T bypasses. The median follow-up was 25 months(interquartile range of 32). Twenty-one preoperative angiographies were performed. Severe femoropopliteal (FP) and IP anatomic patterns(GLASS FP and IP grade 4) were predominant(57% and 86%, respectively) with 100% of limbs classified as GLASS stage III. Three patients(12%) had previously failed endovascular treatment. LBP, PP and SP were, respectively, 75%, 75% and 79% at 1 year, and 61%, 61% and 64% at 2 years. After one year, 86% of the limbs were free from CLTI and 79% of them remained without recurrences during a follow-up of 2 years. Eighty-one percent of the patients were free from major index limb amputation at 2 years. Conclusion: The inverted T bypass is a creative surgical solution for CLTI patients with poor runoff and lacking an adequate venous graft. The results are promising, rendering this technique a viable option for distal and ultra-distal revascularization in complex cases. https://acvjournal.com/index.php/acv/article/view/574Chronic Limb-Threatening IschemiaOpen revascularizationInfrapopliteal diseaseTibioperoneal diseasePeripheral arterial disease |
| spellingShingle | Armanda Duarte Tony R. Soares Gonçalo Cabral Tiago Costa José Tiago José Gimenez Diogo Cunha e Sá Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. Angiologia e Cirurgia Vascular Chronic Limb-Threatening Ischemia Open revascularization Infrapopliteal disease Tibioperoneal disease Peripheral arterial disease |
| title | Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
| title_full | Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
| title_fullStr | Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
| title_full_unstemmed | Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
| title_short | Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
| title_sort | inverted t bypass a solution for distal revascularization in the absence of an adequate autologous vein graft |
| topic | Chronic Limb-Threatening Ischemia Open revascularization Infrapopliteal disease Tibioperoneal disease Peripheral arterial disease |
| url | https://acvjournal.com/index.php/acv/article/view/574 |
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