Background: Chronic limb-threatening ischemia (CLTI) is a severe condition with high risks of amputation and mortality, especially in patients with distal crural or pedal artery disease. Despite advances in endovascular techniques, bypass surgery remains crucial for patients with CLTI. This study aimed to investigate amputation-free survival, Wound, Ischemia, and foot Infection (WIfI) staging, and Global Limb Anatomic Staging System (GLASS) classifications in patients undergoing distal crural or pedal bypass for CLTI. Methods: This retrospective study analyzed all patients who underwent distal crural or pedal bypass for CLTI in a tertiary vascular centre from January 2010 to December 2019. The data were collected from hospital records and preoperative imaging. WIfI stages and GLASS classifications were determined for each patient, and the primary endpoint was amputation-free survival. Secondary outcomes included bypass patency, 30-day morbidity, and mortality. Results: We identified 31 bypasses performed on 29 patients with a median age of 67 years (79% male). Preoperatively, 94% of limbs were staged GLASS III and 55% were classified WIfI stage 4. Failed endovascular revascularization preceded bypass surgery in 65% of the cases. Thirty-day mortality was 3% (n = 1) and 30-day major amputation rate was 10%. Primary patency was 87%, and secondary patency was 94% at 30 days. Median duration of follow-up for survival was 59 months with a mean follow-up index (FUI) of 0.99 ± 0.05, and for major amputation and bypass patency 54 months (mean FUI 0.9 ± 0.19 and 0.85 ± 0.28, respectively). At one year, amputation-free survival was 58%, decreasing to 45% at two years, 39% at three years, and 32% at five years. Most major amputations occurred in WIfI stage 4 patients, but 53% of WIfI stage 4 and 80% of WIfI stage 3 patients were alive without major amputation after one year. Conclusions: Distal crural and pedal bypasses are essential for limb salvage in high-risk CLTI patients, particularly those with failed prior revascularization. However, the procedure is associated with limited long-term amputation-free survival. WIfI and GLASS classifications are useful for stratifying risk and guiding treatment, but outcomes suggest the need for individualized care strategies. Further research into perioperative management and alternative interventions is warranted to improve long-term outcomes in this population.

Zusammenfassung: Hintergrund: Um die Qualität von Dialysezugängen zu verbessern, müssen Daten von Operationen und deren Langzeitergebnisse systematisch und vollständig dokumentiert werden. In der Schweiz verfügt das Swissvasc-Register 2.0 [1] seit 2019 über einen speziellen Datensatz zur Shuntchirurgie. Nun wurden erstmals diese Daten für ein Tertiärspital ausgewertet. Methode: Monozentrische, retrospektive Analyse aller prospektiv erfassten primär oder neu angelegten arteriovenösen Zugänge in 2019/2020. Der Beobachtungszeitraum beträgt 12 Monate. Primärer Endpunkt ist die primäre Offenheitsrate. Sekundäre Endpunkte sind die primär-assistierte/sekundäre und funktionelle Offenheit, die Anzahl Reinterventionen sowie postoperative Komplikationen. Ergebnisse: Sechsundsiebzig AV-Zugänge wurden eingeschlossen. Die primäre Offenheitsrate lag bei 56,5 %. Die primär-assistierte/sekundäre Offenheitsrate betrug 82,9 % resp. 76,3 %. Die funktionelle Offenheitsrate war 51,3 %. Bei 17 (22,4 %) aller Patienten/Patientinnen wurde bereits vor der Operation ein HD-Katheter eingelegt und bei 20 (26,3 %) erfolgte perioperativ eine Einlage. Schlussfolgerungen: Die Ergebnisse für die primäre, primär-assistierte und sekundäre Offenheit sind im Vergleich zu bereits publizierten Daten vergleichbar. Die hohe Rate an HD-Katheter-Einlagen und die fehlende Dokumentation von Daten zur postoperativen Katheter-Einlage muss Anlass sein, die Katheter-Implantation besser zu monitorisieren und durch ein gutes Timing diese zu verhindern. Um eine hohe Behandlungsqualität zu garantieren, braucht es eine interdisziplinäre Zusammenarbeit und die Motivation aller Beteiligten eine hohe Qualität der Dialysezugangschirurgie anzustreben, besonders im Langzeitverlauf.

Antiplatelet and anticoagulation therapy after venous stenting is still not standardized, data from randomized-controlled trials are missing. Rare prothrombotic disorders and nonresponsiveness to drugs must be taken into account. This case report demonstrates successful haemostaselogical complication management in recurrent rethromboses due to underlying clopidogrel resistance and to a responsiveness to anticoagulation with dabigatran after endovascular stent reconstruction of chronic pelvic and caval vein occlusion in a patient with severe postthrombotic syndrome.

Thoracic endovascular aortic repair (TEVAR) is the standard of care for ruptured thoracic aortic aneurysms. A 92-year-old man had presented in stable condition but with acute severe back pain. Computed tomography revealed a ruptured thoracic aortic aneurysm. TEVAR (Valiant; Medtronic Vascular, Santa Rosa, Calif) into zone 2 with intentional coverage of the left subclavian artery was planned. After release of the stent-graft body, proximal release of the bare springs was impossible. Troubleshooting techniques were applied; but tip capture could not be released. Emergent conversion to open repair was performed. Intraoperative device deployment failure in TEVAR is rare. The findings from the present report have demonstrated the advantages of having in-house cardiac surgery backup available.