Appraisal of Ilio-popliteal Bypass Surgery for Limb Salvage (In Patients with Critical Lower Limb Ischemia and Infected Femoral pseudoaneurysms)

Introduction: Critical limb ischemia is usually involving a spectrum of clinical features to describe long term
severe compromise limb perfusion that manifested by rest pain, with or without trophic skin changes or tissue loss,
including ischemic ulceration and/or ischemic gangrene for more than two weeks. A patient who was diagnosed
with infected femoral pseudo aneurysm might be misdiagnosed as a simple groin abscess, and drug abuse is the
most common cause of infected femoral pseudo aneurysms. Long ilio-popliteal bypass in critical limb ischemia may
be required depending on a good arterial segment as a donor and recipient.
Aim: The aim of this study was to assess the different aspects of ilio-popliteal bypass surgery as a long conduit in
patients presented with critical limb ischemia and infected femoral pseudo aneurysms.
Setting and design: Forty patients were admitted in the vascular surgery units, and they were diagnosed with
critical lower limb ischemia. An ilio-popliteal bypass was done to save their limbs. The patients were selected and
divided into two groups; A and B. Group A: This group included twenty patients suffering from atherosclerotic
critical ischemia, while group B included twenty patients suffering from infected femoral pseudo-aneurysm as a
result of intra-arterial drug injection and drug abuse.
Patients and methods: All patients were assessed at the pre-operative stage as regards to the present conditions
and symptoms related to critical lower limb ischemia; the lower limb was locally examined as well. Angiography was
done for all patients. Ilio-popliteal bypass using a PTFE synthetic graft was done, with station on the deep femoral
artery in certain patients, anatomically in group A, and placed laterally extra anatomic in group B after ligation of
the pseudo aneurysm. One year follow up was conducted mainly clinically and by the ankle brachial pressure index
(ABI).
Statistical analysis: Statistical Package for the Social Sciences, version 15.0 was used. Values were compared
with a paired samples t test. P values less than 0.05 were considered significant.
Results: During the follow up period, the ABI values were recorded immediately after the procedure, 24 hours,
one week, and then one, three, six and twelve months later. There were no significant changes in the ABI changes
among patients indicating the continuation of the hemodynamic success. At the end of the study follow up period,
limb salvage rate was 90%, and four major amputation following graft occlusion took place in the twenty studied
patients. Primary patency was 80% as eight grafts were occluded.
Conclusions: Although the ilio-popliteal bypass is a long conduit, it is a reasonable solution for limb salvage in
patients with critical limb ischemia, anatomical bypass with station on the deep femoral artery should be performed
when possible, meanwhile in drug abuse cases with infected groin pseudo aneurysm, the healthy arterial axis is
maintaining the patency of the long lateral extra anatomic graft.