Branched crural bypass has no advantage over simple crural bypass in the treatment of peripheral arterial disease

This retrospective study compared mid-term outcome of a simple crural bypass (SCB, n=72) and branched crural bypass (BCB, n=23) constructed with reverse or in situ saphenous grafts or prosthetic grafts in patients with peripheral arterial disease grade III to IV (Fontaine classification) and type D lesions (TASC II classification). Life table analysis showed comparable primary (P=0.83), assisted (P=0.76), and secondary patency rates (P=0.78), limb salvage rates (P=0.64), and survival rates (P=0.81) between BCB and SCB. Comparison between the saphenous vein grafts and prosthetic grafts showed better primary (P=0.0089), assisted (P=0.0013), and secondary patency rates (P=0.0089) where venous grafts were used, but not limb salvage rates (P=0.072). In the SCB group, anastomoses to the anterior tibial artery had worse primary (P=0.023), assisted (P=0.035), and secondary (P=0.042) patency rates, but comparable limb salvage rates (P=0.57). We conclude that BCB provides no advantage but also no additional risk for the patient. When choosing a target crural artery, evidence shows the posterior tibial artery or fibular artery should be preferred to the anterior tibial artery.