Abstract
Introduction: The development of chronic peripheral arteriopathy in the infrapatellar axis is closely related to diabetes. The disease's most advanced stages are a frequent reason for consultation and hospitalization, generally due to unhealed lesions of long
evolution. In many cases, the need to revascularize the axis is crucial to prevent its progression and improve its evolution. Failure to act in the resolution may lead to the compromise of the limb up to its loss.
Objective: To disseminate a surgical team's experience using infrapatellar bypass as a valuable resource in preventing amputations due to ischemia.
Material and methods: A retrospective study of 87 infrapatellar revascularizations by the same surgical team from April 2023 to June 2024, with venous bypass as the revascularization method.
Results: The most frequent complication after the procedure was wound dehiscence (28%); major amputation was observed in approximately 6%. Of the sample, 89% (78 patients) maintained the bypass permeable at 3 months. Of the remaining patients, 5
underwent amputation, and 4 had thrombosis within the first 10 days.
Conclusion: Infrapatellar bypass has proven to be an effective revascularization option. It can improve the quality of life and survival rate by avoiding serious complications associated with ischemia.
References
Surmann J, Meyer P, Epple J, Schmitz-Rixen T, Böckler D, Grundmann RT; DIGG. Long-Term Outcome of Lower Extremity Bypass Surgery in Diabetic and Non-Diabetic Patients with Critical Limb-Threatening Ischaemia in Germany. Biomedicines. 2024;12(1):38. https://doi.org/10.3390/biomedicines12010038. PMID: 38255145; PMCID: PMC10813329.
Pourghaderi P, et al. Outcomes following Lower Extremity Amputation in Patients with Diabetes Mellitus and Peripheral Arterial Diseas. Annals of Vascular Surgery. 2020; 63:259-268. https://doi.org/10.1016/j.avsg.2019.08.084.
Organización Mundial de la Salud: https://www.who.int/es/newsroom/fact-sheets/detail/diabetes.
Russo MP, Grande-Ratti MF, Burgos MA, Molaro AA, Bonella MB. Prevalence of diabetes, epidemiological characteristics and vascular complications. Arch Cardiol Mex. 2023;93(1):30-36. English. https://doi.org/10.24875/ACM.21000410. PMID: 36757785; PMCID: PMC10161833.
Walicka M, Raczyńska M, Marcinkowska K, Lisicka I, Czaicki A, Wierzba W, Franek E. Amputations of Lower Limb in Subjects with Diabetes Mellitus: Reasons and 30-Day Mortality. J Diabetes Res.;2021:8866126. https://pmc.ncbi.nlm.nih.gov/articles/PMC8328738/. PMID: 34350296; PMCID: PMC8328738.
Almasri J, Adusumalli J, Asi N, Lakis S, Alsawas M, Prokop LJ, Bradbury A, Kolh P, Conte MS, M urad MH. A systematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 2019;58(1S):S110-S119. https://doi.org/10.1016/j.ejvs.2019.04.013. Epub 2019 Jun 17. PMID: 31221539.
Carro GV, Saurral RN, Witman EL, Alterini P, Braver JD, Carrió LM, Issa C, David R. Clinical features and outcomes of diabetic foot in Argentina: a longitudinal multicenter study. Medicina (B Aires). 2023;83(3):428-441. English. PMID: 37379540.
Giles, Kristina A. et al. Surgery or endovascular therapy for patients with chronic limb-threatening ischemia requiring infrapopliteal interventions. Journal of Vascular Surgery, 2024;80(5):1515-1524. https://doi.org/10.1016/j.jvs.2024.05.049.
Pomposelli FB, Kansal N, Hamdan AD, Belfield A, Sheahan M, Campbell DR, Skillman JJ, Logerfo FW. A decade of experience with dorsalis pedis artery bypass: analysis of outcome in more than 1000 cases. J Vasc Surg. 2003;37(2):307-15. https://doi.org/10.1067/mva.2003.125. PMID: 12563200.
