Vnitr Lek 2005, 51(2):163-166

Pedal bypass in the treatment of diabetic foot ischemia - midterm results

P. Tošenovský^1,*, B. Zálešák², L. Janoušek¹, B. Kožnar³, J. Peregrin³

¹ Klinika transplantační chirurgie IKEM, Praha, přednosta doc. MUDr. M. Ryska, CSc.

² Oddělení plastické a estetické chirurgie FN Olomouc, přednosta prim. MUDr. P. Hartl

³ Klinika intervenční radiologie IKEM, Praha, přednosta doc. MUDr. J. Peregrin, CSc.

Background:
Unacceptably high percentage of diabetics undergo major amputation of their lower limbs annually. An occlusive aterosclerosis of crural arteries is major cause of amputations of those patients. The end stage of such process is development of ulcerations and gangrene of the foot. A progress in revascularisation techniques led to a more aggressive approach to solve this issue within last few years and specially methods of interventional radiology reached good results in the inrapopliteal region. However the scope of percutaneous techniques is limited and fail in defined number of patients. Pedal bypass is a good alternative for salvage of diabetic feet with critical ischemia as reported in many papers.

Aim:
The principal aim of this study was to evaluate retrospectively six years of focused effort to save diabetic feet by means of pedal bypass in situations, where the other types of revascularisation technique were not possible.

Material and methods:
Total 68 critically ischemic lower limbs were assigned for pedal bypass at the Department of Transplant Surgery IKEM within the period 1996-2002. Indication for such procedure was always the end stage of lower limb occlusive atherosclerosis with non-healing ulceration or gangrene of diabetic feet where an extensive destruction of crural arteries was diagnosed (possibly even associated with occlusion of arteries in femoropopliteal region). This retrospective study included only diabetics with revascularisation performed using distal anastomosis below the level of malleolus. Postoperative follow-up was performed regularly with duplex ultrasound and median of follow-up was 28 months (1-78).

Results:
Out of 68 lower limbs indicated to a pedal bypass revascularisation procedure was performed in 60 limbs, eight times only exploration of target pedal arteries were performed. One year secondary and primary patenty rates were 67% and 46%, respectively. Two years secondary and primary patenty rates were 52% and 29%, respectively. One year and two years limb salvage rates were achieved in 71% and 68%, respectively. Thirty days mortality rate was 0%, morbidity rate in the same period was 9.5%.

Conclusion:
Pedal bypass has acceptable two years patency rate according to these results. Pedal bypass is associated with zero mortality and with low morbidity rates. Applying this surgical technique one can achieve 68% limb salvage within two years.

Keywords: pedal bypass; diabetic foot; ischemia; limb salvage

Received: September 25, 2003; Accepted: February 19, 2004; Published: February 1, 2005  Show citation