TY - JOUR
T1 - Combined free tissue transfer and infrainguinal bypass graft
T2 - An alternative to major amputation in selected patients
AU - Illig, Karl A.
AU - Moran, Steve
AU - Serletti, Joseph
AU - Ouriel, Kenneth
AU - Orlando, Greg
AU - Smith, Andrew
AU - Shortell, Cynthia K.
AU - Green, Richard M.
PY - 2001
Y1 - 2001
N2 - Objectives: The purpose of this study was to document outcome and adverse prognostic factors in patients requiring combined free tissue transfer and distal bypass grafting for otherwise nonreconstructible infrainguinal arterial occlusive disease and advanced tissue necrosis. Methods: Between July 1990 and November 1999, 65 patients, all of whom would have required at least below-knee amputation, underwent free tissue transfer in conjunction with infrainguinal bypass grafting at the University of Rochester. Preoperative variables were assessed for their influence on outcome with χ2 and outcome with life-table analysis with Cox proportionate hazard testing. Results: Free tissue transfer was performed synchronously with arterial reconstruction with autologous vein in 49 patients and after a previous functioning venous bypass graft in 16 patients. The 30-day mortality rate was 5%, and major complications occurred in another 16% of patients. Flap location, weight-bearing status, preexisting osteomyelitis, and the timing of bypass grafting relative to flap construction had no effect on outcome. All five free flap failures occurred within the first 30 days. All other flaps subsequently survived, even in seven patients whose bypass grafts thrombosed. Five-year limb salvage and patient survival rates were 57% and 60%, respectively, and 65% of patients regained meaningful ambulation. The combination of diabetes and dialysis-dependent renal failure was the strongest predictor of overall limb loss (P < .005; relative risk = 4.0), and diabetes alone was the strongest predictor of death (P < .02; relative risk = 5.2). Conclusion: Free tissue transfer combined with infrainguinal bypass grafting in selected patients is safe and effective. The combination of diabetes and chronic renal insufficiency, particularly the need for dialysis, is a powerful predictor of failure and should be considered a strong contraindication for this procedure.
AB - Objectives: The purpose of this study was to document outcome and adverse prognostic factors in patients requiring combined free tissue transfer and distal bypass grafting for otherwise nonreconstructible infrainguinal arterial occlusive disease and advanced tissue necrosis. Methods: Between July 1990 and November 1999, 65 patients, all of whom would have required at least below-knee amputation, underwent free tissue transfer in conjunction with infrainguinal bypass grafting at the University of Rochester. Preoperative variables were assessed for their influence on outcome with χ2 and outcome with life-table analysis with Cox proportionate hazard testing. Results: Free tissue transfer was performed synchronously with arterial reconstruction with autologous vein in 49 patients and after a previous functioning venous bypass graft in 16 patients. The 30-day mortality rate was 5%, and major complications occurred in another 16% of patients. Flap location, weight-bearing status, preexisting osteomyelitis, and the timing of bypass grafting relative to flap construction had no effect on outcome. All five free flap failures occurred within the first 30 days. All other flaps subsequently survived, even in seven patients whose bypass grafts thrombosed. Five-year limb salvage and patient survival rates were 57% and 60%, respectively, and 65% of patients regained meaningful ambulation. The combination of diabetes and dialysis-dependent renal failure was the strongest predictor of overall limb loss (P < .005; relative risk = 4.0), and diabetes alone was the strongest predictor of death (P < .02; relative risk = 5.2). Conclusion: Free tissue transfer combined with infrainguinal bypass grafting in selected patients is safe and effective. The combination of diabetes and chronic renal insufficiency, particularly the need for dialysis, is a powerful predictor of failure and should be considered a strong contraindication for this procedure.
UR - http://www.scopus.com/inward/record.url?scp=0035145386&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035145386&partnerID=8YFLogxK
U2 - 10.1067/mva.2001.112301
DO - 10.1067/mva.2001.112301
M3 - Article
C2 - 11137919
AN - SCOPUS:0035145386
SN - 0741-5214
VL - 33
SP - 17
EP - 23
JO - Journal of vascular surgery
JF - Journal of vascular surgery
IS - 1
ER -