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INFRAGENICULAR-BYPASS-REVASCULARISATION.pptx

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arul velusamy
arul velusamy

This study aims to evaluate the role of revascularization procedures below the knee in limb salvage for patients with femoropopliteal occlusive disease. 82 patients with critical limb ischemia due to femoropopliteal occlusion underwent infragenicular bypass revascularization. Pre-operative and post-operative pain scores, ankle-brachial indices, ulcer healing times, and graft patency rates were analyzed to assess outcomes. The results suggest that infragenicular bypass can effectively salvage limbs and improve symptoms in patients with below-knee arterial occlusions.

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Limb salvage in patients with femoropopliteal occlusive disease by infra genicular bypass revascularization – A retrospective analytical study. Dr.V.Arul Madurai Medical College
Introduction • Femoro-popliteal occlusive disease frequently presents with critical limb ischemia in later stages • It usually doesn’t respond to early conservative management and eventually leads to amputation of the limb. • Limb salvage requires revascularization procedures • But only in 7% of the symptomatic PAOD, revascularization procedures are done, according to literature.
Why this study? • Revascular procedures are not performed routinely for the below knee occlusive diseases due to the • Technical difficulty to perform anastamosis in low caliber vessels below knee • Poor outcome after the infra genicular bypasses as per literature • Surgical treatment for TAO is limited • Our aim is to evaluate the role of revascularisation procedures below knee in limb salvage • And analyse their outcome in cases of femoropopliteal occlusion.
Inclusion & Exclusion criteria Inclusion Exclusion • Patients proven of peripheral arterial occlusive disease (by CT angiogram) •TAO •Atherosclerotic Occlusion • Patients with critical limb ischemia (ABI <0.9) • Arterial occlusion above the level of knee joint
Materials and Methods • Study was carried out in the Department of Vascular surgery, Govt Rajaji Hospital, Madurai , between Feb 2014 to Jan 2015. • 82 patients, proven of femoro popliteal occlusive disease (by CT angiogram) , with critical limb ischemia were taken in to study. • Initial presentation, Preop pain score, Preop ABI, Co morbid conditions, Level of occlusion in CT angiogram were noted. Preop Diagnosis was made.
Materials & Methods • Inflow vessel & Level of anastamosis (target artery) during surgery were recorded. • Patient was followed up after 6 months, and improvements in rest pain (Postop pain score), time taken for ulcer healing, post procedure ABI, duplex doppler are noted. • The results are evaluated using SPSS software.
Surgery – Femoropoleteal Bypass • Inflow vessel : •common femoral artery • superficial femoral artery •popliteal artery • Target vessel : •Anterior tibial artery •Peroneal artery •Mid posterior tibial artery •Distal posterior tibial •Distal popliteal artery
COMMON FEMORAL DEEP FEMORAL SUPERFICIAL FEMORAL POPLITEAL ARTERY POSTERIOR TIBIAL ANTERIOR TIBIAL PERONEAL ARTERY
RESULTS
INFRAGENICULAR-BYPASS-REVASCULARISATION.pptx
INFRAGENICULAR-BYPASS-REVASCULARISATION.pptx
INFRAGENICULAR-BYPASS-REVASCULARISATION.pptx
INFRAGENICULAR-BYPASS-REVASCULARISATION.pptx
Inflow vessel

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INFRAGENICULAR-BYPASS-REVASCULARISATION.pptx

  • 1. Limb salvage in patients with femoropopliteal occlusive disease by infra genicular bypass revascularization – A retrospective analytical study. Dr.V.Arul Madurai Medical College
  • 2. Introduction • Femoro-popliteal occlusive disease frequently presents with critical limb ischemia in later stages • It usually doesn’t respond to early conservative management and eventually leads to amputation of the limb. • Limb salvage requires revascularization procedures • But only in 7% of the symptomatic PAOD, revascularization procedures are done, according to literature.
  • 3. Why this study? • Revascular procedures are not performed routinely for the below knee occlusive diseases due to the • Technical difficulty to perform anastamosis in low caliber vessels below knee • Poor outcome after the infra genicular bypasses as per literature • Surgical treatment for TAO is limited • Our aim is to evaluate the role of revascularisation procedures below knee in limb salvage • And analyse their outcome in cases of femoropopliteal occlusion.
  • 4. Inclusion & Exclusion criteria Inclusion Exclusion • Patients proven of peripheral arterial occlusive disease (by CT angiogram) •TAO •Atherosclerotic Occlusion • Patients with critical limb ischemia (ABI <0.9) • Arterial occlusion above the level of knee joint
  • 5. Materials and Methods • Study was carried out in the Department of Vascular surgery, Govt Rajaji Hospital, Madurai , between Feb 2014 to Jan 2015. • 82 patients, proven of femoro popliteal occlusive disease (by CT angiogram) , with critical limb ischemia were taken in to study. • Initial presentation, Preop pain score, Preop ABI, Co morbid conditions, Level of occlusion in CT angiogram were noted. Preop Diagnosis was made.
  • 6. Materials & Methods • Inflow vessel & Level of anastamosis (target artery) during surgery were recorded. • Patient was followed up after 6 months, and improvements in rest pain (Postop pain score), time taken for ulcer healing, post procedure ABI, duplex doppler are noted. • The results are evaluated using SPSS software.
  • 7. Surgery – Femoropoleteal Bypass • Inflow vessel : •common femoral artery • superficial femoral artery •popliteal artery • Target vessel : •Anterior tibial artery •Peroneal artery •Mid posterior tibial artery •Distal posterior tibial •Distal popliteal artery
  • 8. COMMON FEMORAL DEEP FEMORAL SUPERFICIAL FEMORAL POPLITEAL ARTERY POSTERIOR TIBIAL ANTERIOR TIBIAL PERONEAL ARTERY