Re-Do Operations after Failed Multisegmental Reconstructive Arterial Surgery for Critical Limb Ischaemia

The purpose of this study was to investigate the long-term graft patency rates after multisegmental arterial reconstruction for treatment of chronic critical limb ischemia, and to evaluate the role of re-do surgery in treatment of graft failure. A total of 449 aortofemoropopliteal/tibial grafts carried out over a 10-year period were retrospectively reviewed. All patients were operated upon with chronic critical limb ischemia grade III and IV according to the Fontaine classification; 221 operations were performed in one stage (group A), and 228 in two stages (group B). Distribution of graft failures in the postoperative period, re-do operations and their impact on limb salvage were investigated using life-table methods. During follow up, 62 cases of inflow graft thrombosis were observed (23 in group A and 39 in group B). To correct the inflow graft failure, 59 re-do procedures were performed (27 in group A, 32 in group B). Inflow graft failures were most common during 24 months after primary surgery. During the same period, 92 cases of isolated outflow graft thrombosis were observed (45 in group A and 47 in group B). Outflow graft thromboses were most common after 24–36 months. For