Popliteal-to-distal extreme bypass in endovascular era

Objectives Chronic limb-threatening ischemia (CLTI) is characterized by rest pain and tissue loss, with an annual mortality rate of 20% and amputation rate of 40%, if not treated. Open bypass surgery is recommended in CLTI, depending on the availability of good quality venous material, outflow artery patency and surgical expertise. Aim of the study is to analyze primary patency, limb salvage and survival rate in patient undergoing popliteal-to-distal bypass. Methods All consecutive patients who underwent popliteal-to-distal bypass surgery between January 2016 and December 2021 were enrolled in the study. Primary outcomes were primary patency, limb salvage and overall survival. Secondary outcomes included amputation-free survival and secondary patency. Results Forty-nine patients were included during the study. Technical success was achieved in 100% of cases. Target outflow artery was in 27% (n. 13) of cases the anterior tibial artery in 27% (n. 13) dorsalis pedis, in 2% (n. 1) the peroneal artery, in 30% (n. 15) the retro-malleolar tibial artery, in 10% (n. 5) the medial plantar artery, in 4% (n. 2) the tarsal artery. Two-year primary patency was 85%±5. Secondary patency rates was 86%±3 at two years. The overall survival was 81% ±6 at 2 years, the amputation free survival was 70% ±9, and the limb salvage rate was 81% ±6. Conclusion Popliteal-to-distal bypass require high technical expertise to be performed. When a good autologous vein and adequate outflow artery are present, they can be feasible with good patency rates, and overall survival. Keywords