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Combined free tissue transfer and infrainguinal bypass graft: an alternative to major amputation in selected patients.

Publication ,  Journal Article
Illig, KA; Moran, S; Serletti, J; Ouriel, K; Orlando, G; Smith, A; Shortell, CK; Green, RM
Published in: J Vasc Surg
January 2001

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 chi(2) 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.

Duke Scholars

Published In

J Vasc Surg

DOI

ISSN

0741-5214

Publication Date

January 2001

Volume

33

Issue

1

Start / End Page

17 / 23

Location

United States

Related Subject Headings

  • Veins
  • Treatment Outcome
  • Survival Rate
  • Surgical Flaps
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Prognosis
  • Leg
  • Ischemia
 

Citation

APA
Chicago
ICMJE
MLA
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Illig, K. A., Moran, S., Serletti, J., Ouriel, K., Orlando, G., Smith, A., … Green, R. M. (2001). Combined free tissue transfer and infrainguinal bypass graft: an alternative to major amputation in selected patients. J Vasc Surg, 33(1), 17–23. https://doi.org/10.1067/mva.2001.112301
Illig, K. A., S. Moran, J. Serletti, K. Ouriel, G. Orlando, A. Smith, C. K. Shortell, and R. M. Green. “Combined free tissue transfer and infrainguinal bypass graft: an alternative to major amputation in selected patients.J Vasc Surg 33, no. 1 (January 2001): 17–23. https://doi.org/10.1067/mva.2001.112301.
Illig KA, Moran S, Serletti J, Ouriel K, Orlando G, Smith A, et al. Combined free tissue transfer and infrainguinal bypass graft: an alternative to major amputation in selected patients. J Vasc Surg. 2001 Jan;33(1):17–23.
Illig, K. A., et al. “Combined free tissue transfer and infrainguinal bypass graft: an alternative to major amputation in selected patients.J Vasc Surg, vol. 33, no. 1, Jan. 2001, pp. 17–23. Pubmed, doi:10.1067/mva.2001.112301.
Illig KA, Moran S, Serletti J, Ouriel K, Orlando G, Smith A, Shortell CK, Green RM. Combined free tissue transfer and infrainguinal bypass graft: an alternative to major amputation in selected patients. J Vasc Surg. 2001 Jan;33(1):17–23.
Journal cover image

Published In

J Vasc Surg

DOI

ISSN

0741-5214

Publication Date

January 2001

Volume

33

Issue

1

Start / End Page

17 / 23

Location

United States

Related Subject Headings

  • Veins
  • Treatment Outcome
  • Survival Rate
  • Surgical Flaps
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Prognosis
  • Leg
  • Ischemia