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Predictors of outcome when reoperating for early infrainguinal bypass occlusion
J V Lombardi1, M J Dougherty, K D Calligaro
1Section on Vascular Surgery, Pennsylvania Hospital, Philadelphia 19106, USA.
Insights
Predicting outcomes for early infrainguinal graft thrombosis is crucial. Key factors like conduit type, repair method, run-off, and operative findings significantly influence graft survival and limb salvage success.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
Background:
- Early infrainguinal graft thrombosis (<30 days) presents a significant challenge in limb salvage surgery.
- Identifying predictive factors for intervention outcomes is essential for optimizing patient management.
Purpose of the Study:
- To identify factors that predict the outcome of interventions for early infrainguinal graft thrombosis.
- To inform clinical decision-making regarding graft repair versus amputation.
Main Methods:
- Retrospective review of medical records, arteriograms, and follow-up studies.
- Analysis of patients undergoing infrainguinal bypass for limb salvage with graft failure within 30 days.
- Evaluation of five factors: conduit type, repair modality, run-off, operative findings, and surgical history.
Main Results:
- Conduit type, repair modality, run-off status, operative findings (correctable vs. noncorrectable), and prior ipsilateral bypass were identified as statistically significant risk factors.
- These variables, when analyzed in combination, can predict patient outcomes.
Conclusions:
- Complete graft replacement should be considered for infrainguinal graft thrombosis, especially when a clear, correctable lesion is not identified.
- Primary amputation may be a more appropriate strategy when adverse risk factors are present, considering the morbidity and costs of repeated procedures.
Abstract:
The purpose of this study is to identify factors that predict outcome after intervention for early (<30 days) infrainguinal graft thrombosis. We reviewed the medical records, arteriograms, and follow-up studies of patients who underwent infrainguinal bypass for limb salvage between 8/91 and 9/98 and whose graft failed <30 days from the index procedure. Five factors were analyzed: (1) conduit: single segment saphenous vein versus alternative vein or composite conduit (20 vs. 13 patients); (2) repair modality: construction of a new graft at the time of the initial take-back procedure versus local revision and/or thrombectomy alone (12 vs. 21 patients); (3) run-off: good run-off versus poor run-off (20 vs. 13 patients); (4) operative findings: the presence of a correctable problem versus noncorrectable problem (20 vs. 13 patients); and (5) surgical history: previous versus no previous ipsilateral bypass (16 vs. 17 patients). These variables are statistically significant risk factors that can be used in combination to predict outcome. Unless a focal lesion clearly responsible for graft occlusion is found, complete graft replacement should be considered even if the new bypass must be prosthetic. The costs and morbidity of repeated procedures argue for primary amputation when adverse risk factors exist.