Background: The results of paramalleolar distal bypass for critical limb ischemia in patients with peripheral arterial disease were reviewed to determine the factors affecting the long-term patency of this procedure in Japanese subjects.
Methods and results: A total of 65 legs from 60 consecutive Japanese patients with critical limb ischemia who underwent distal bypass to the ankle were retrospectively reviewed. Postoperative graft patency, morbidity and mortality were analyzed. All patients were monitored during a mean follow-up period of 2.2 ± 1.7 years (median, 1.7 years). The accumulated primary and secondary patency rates were both 81.0% at 1 year and 78.7% at 3 and 5 years. The amputation-free rates and survival rates at 1 year, and 3 and 5 years were 94.5% and 82.6%, 82.6% and 88.1%, and 76.7% and 69.7%, respectively. The Cox proportional hazard model was used to determine factors contributing to long-term results. Age (odds ratio, 1.1; P<0.05) and diabetes (odds ratio, 18.0; P<0.05) were found to be the significant determinant factors of graft occlusion. No variables were found to be significant determinant factors of amputation-free or survival rates.
Conclusions: Distal bypass to the paramalleolar tibial artery is an effective strategy for peripheral arterial disease with reasonable long-term reliability. Diabetes and old age were found to be the possible determinant factors of graft failure in Japanese patients.