Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft.
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.574 |
Resumo: | Introduction: Peripheral arterial disease has become a worldwide problem, with chronic limb-threatening ischemia(CLTI) being its most extreme manifestation. Recently, endovascular strategies evolved and became the first approach in many revascularization procedures. However, infrapopliteal (IP) disease is still a therapeutic challange.1–3 This study aims to present a surgical technique, named inverted T bypass, that can be applied to patients with: an IP artery with poor collateralization to the foot, an inframalleolar artery with poor runoff and availability of only a short venous graft.4 Methods: A single-center retrospective analysis of all patients submitted to inverted T bypass. The end points of the present study were limb-based patency(LBP), primary patency(PP) and secondary patency(SP) rates, freedom from CLTI, recurrence of CLTI, freedom from major index limb amputation, amputation free-survival, and overall survival. Results: A total of twenty-five patients with CLTI (68% male) with a median age of 77 years were submitted to 25 inverted T bypasses. The median follow-up was 25 months(interquartile range of 32). Twenty-one preoperative angiographies were performed. Severe femoropopliteal (FP) and IP anatomic patterns(GLASS FP and IP grade 4) were predominant(57% and 86%, respectively) with 100% of limbs classified as GLASS stage III. Three patients(12%) had previously failed endovascular treatment. LBP, PP and SP were, respectively, 75%, 75% and 79% at 1 year, and 61%, 61% and 64% at 2 years. After one year, 86% of the limbs were free from CLTI and 79% of them remained without recurrences during a follow-up of 2 years. Eighty-one percent of the patients were free from major index limb amputation at 2 years. Conclusion: The inverted T bypass is a creative surgical solution for CLTI patients with poor runoff and lacking an adequate venous graft. The results are promising, rendering this technique a viable option for distal and ultra-distal revascularization in complex cases. |
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Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft.Chronic Limb-Threatening IschemiaOpen revascularizationInfrapopliteal diseaseTibioperoneal diseasePeripheral arterial diseaseIntroduction: Peripheral arterial disease has become a worldwide problem, with chronic limb-threatening ischemia(CLTI) being its most extreme manifestation. Recently, endovascular strategies evolved and became the first approach in many revascularization procedures. However, infrapopliteal (IP) disease is still a therapeutic challange.1–3 This study aims to present a surgical technique, named inverted T bypass, that can be applied to patients with: an IP artery with poor collateralization to the foot, an inframalleolar artery with poor runoff and availability of only a short venous graft.4 Methods: A single-center retrospective analysis of all patients submitted to inverted T bypass. The end points of the present study were limb-based patency(LBP), primary patency(PP) and secondary patency(SP) rates, freedom from CLTI, recurrence of CLTI, freedom from major index limb amputation, amputation free-survival, and overall survival. Results: A total of twenty-five patients with CLTI (68% male) with a median age of 77 years were submitted to 25 inverted T bypasses. The median follow-up was 25 months(interquartile range of 32). Twenty-one preoperative angiographies were performed. Severe femoropopliteal (FP) and IP anatomic patterns(GLASS FP and IP grade 4) were predominant(57% and 86%, respectively) with 100% of limbs classified as GLASS stage III. Three patients(12%) had previously failed endovascular treatment. LBP, PP and SP were, respectively, 75%, 75% and 79% at 1 year, and 61%, 61% and 64% at 2 years. After one year, 86% of the limbs were free from CLTI and 79% of them remained without recurrences during a follow-up of 2 years. Eighty-one percent of the patients were free from major index limb amputation at 2 years. Conclusion: The inverted T bypass is a creative surgical solution for CLTI patients with poor runoff and lacking an adequate venous graft. The results are promising, rendering this technique a viable option for distal and ultra-distal revascularization in complex cases.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2023-11-26info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.574https://doi.org/10.48750/acv.574Angiologia e Cirurgia Vascular; Vol. 19 No. 3 (2023): September; 171-177Angiologia e Cirurgia Vascular; Vol. 19 N.º 3 (2023): Setembro; 171-1772183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/574http://acvjournal.com/index.php/acv/article/view/574/350Copyright (c) 2023 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessDuarte, ArmandaR. Soares, TonyCabral, GonçaloCosta, TiagoTiago, JoséGimenez, JoséCunha e Sá, Diogo2023-12-01T10:30:19Zoai:ojs.acvjournal.com:article/574Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T00:40:28.875763Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
title |
Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
spellingShingle |
Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. Duarte, Armanda Chronic Limb-Threatening Ischemia Open revascularization Infrapopliteal disease Tibioperoneal disease Peripheral arterial disease |
title_short |
Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
title_full |
Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
title_fullStr |
Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
title_full_unstemmed |
Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
title_sort |
Inverted T bypass: a solution for distal revascularization in the absence of an adequate autologous vein graft. |
author |
Duarte, Armanda |
author_facet |
Duarte, Armanda R. Soares, Tony Cabral, Gonçalo Costa, Tiago Tiago, José Gimenez, José Cunha e Sá, Diogo |
author_role |
author |
author2 |
R. Soares, Tony Cabral, Gonçalo Costa, Tiago Tiago, José Gimenez, José Cunha e Sá, Diogo |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Duarte, Armanda R. Soares, Tony Cabral, Gonçalo Costa, Tiago Tiago, José Gimenez, José Cunha e Sá, Diogo |
dc.subject.por.fl_str_mv |
Chronic Limb-Threatening Ischemia Open revascularization Infrapopliteal disease Tibioperoneal disease Peripheral arterial disease |
topic |
Chronic Limb-Threatening Ischemia Open revascularization Infrapopliteal disease Tibioperoneal disease Peripheral arterial disease |
description |
Introduction: Peripheral arterial disease has become a worldwide problem, with chronic limb-threatening ischemia(CLTI) being its most extreme manifestation. Recently, endovascular strategies evolved and became the first approach in many revascularization procedures. However, infrapopliteal (IP) disease is still a therapeutic challange.1–3 This study aims to present a surgical technique, named inverted T bypass, that can be applied to patients with: an IP artery with poor collateralization to the foot, an inframalleolar artery with poor runoff and availability of only a short venous graft.4 Methods: A single-center retrospective analysis of all patients submitted to inverted T bypass. The end points of the present study were limb-based patency(LBP), primary patency(PP) and secondary patency(SP) rates, freedom from CLTI, recurrence of CLTI, freedom from major index limb amputation, amputation free-survival, and overall survival. Results: A total of twenty-five patients with CLTI (68% male) with a median age of 77 years were submitted to 25 inverted T bypasses. The median follow-up was 25 months(interquartile range of 32). Twenty-one preoperative angiographies were performed. Severe femoropopliteal (FP) and IP anatomic patterns(GLASS FP and IP grade 4) were predominant(57% and 86%, respectively) with 100% of limbs classified as GLASS stage III. Three patients(12%) had previously failed endovascular treatment. LBP, PP and SP were, respectively, 75%, 75% and 79% at 1 year, and 61%, 61% and 64% at 2 years. After one year, 86% of the limbs were free from CLTI and 79% of them remained without recurrences during a follow-up of 2 years. Eighty-one percent of the patients were free from major index limb amputation at 2 years. Conclusion: The inverted T bypass is a creative surgical solution for CLTI patients with poor runoff and lacking an adequate venous graft. The results are promising, rendering this technique a viable option for distal and ultra-distal revascularization in complex cases. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-11-26 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.574 https://doi.org/10.48750/acv.574 |
url |
https://doi.org/10.48750/acv.574 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://acvjournal.com/index.php/acv/article/view/574 http://acvjournal.com/index.php/acv/article/view/574/350 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2023 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2023 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 19 No. 3 (2023): September; 171-177 Angiologia e Cirurgia Vascular; Vol. 19 N.º 3 (2023): Setembro; 171-177 2183-0096 1646-706X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799136309802958848 |