AB075. SOH25_AB_276. Ultra-distal bypass remains a valuable option for tibial disease with tissue loss—a case series

Background: The pattern of distal tibial calcific disease associated with chronic kidney disease (CKD) and diabetes is challenging to revascularize. Ultra-distal bypass, on to pedal or plantar vessels, is an option for patients who have failed an endovascular approach. The goal of such ultra-distal bypasses is often to achieve wound healing rather than long-term patency. We present a case series from an Irish tertiary vascular centre.

Methods: A retrospective review of all ultra-distal bypasses since 2019 was performed. Cases were identified from theatre logs. Electronic health records and formal charts were used to record demographics, comorbidities and outcomes. Statistical analysis was performed using SPSS (Statistical package for social sciences).

Results: Since 2019, 25 limbs in 23 patients underwent ultra-distal bypass for tissue loss, 16 to pedal vessels and 9 to plantars. All patients were male and median age was 62.0 years (range, 43–85 years). Seventy-two percent (n=18) of the cohort were diabetic, 9 (36%) had CKD, 4 (16%) were dialysis-dependent and 5 (20%) had congestive heart failure. Median follow-up duration was 14 months (range, 0–51 months). At 12 months, freedom from graft failure was 68% (n=17) and freedom from major amputation was 92% (n=23). At most recent clinic review, 85% (n=17) of wounds had healed.

Conclusions: Ultra-distal bypasses are a valuable tool in a vascular surgeon’s arsenal for tissue loss in patients with complex tibial disease. Though the durability of bypass was variable, the majority of patients included in this study healed their ulcers and only three limbs progressed to major amputation.

Keywords: Chronic kidney disease (CKD); diabetic; distal bypass; patency; wound