Single-center experience in endovascular treatment for infrainguinal bypass obstructions
Frederic Baumann1, Rolf P Engelberger, Vladimir Makaloski
1Department of General Internal Medicine, Inselspital, University Hospital of Bern, Freiburgstrasse, Bern, Switzerland.
Insights
Endovascular therapy offers a viable option for infrainguinal bypass obstructions, improving outcomes for intermittent claudication (IC) more than critical limb ischemia (CLI). Critical limb ischemia and poor runoff independently predict lower patency rates in bypass interventions.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Peripheral Artery Disease
Background:
- Infrainguinal bypass obstructions pose significant challenges in vascular surgery.
- Endovascular therapy is increasingly explored as an alternative to traditional bypass surgery.
- Evaluating the efficacy of endovascular treatments for bypass complications is crucial.
Purpose of the Study:
- To assess the patency and clinical effectiveness of endovascular therapy for infrainguinal bypass obstructions.
- To compare outcomes based on patient symptoms (IC vs. CLI), graft material, and anastomosis location.
Main Methods:
- Retrospective analysis of 54 patients undergoing endovascular therapy for infrainguinal bypass obstructions.
- Categorization by symptom severity (IC/CLI), graft type (autologous/prosthetic), and distal anastomosis site.
- Definition of primary, assisted primary, and secondary patency, along with clinical improvement metrics.
Main Results:
- One-year primary patency rates were 74% for IC and 27% for CLI (P=.001).
- Primary sustained clinical improvement was 64% for IC versus 25% for CLI (P=.018).
- Critical limb ischemia (HR 7.8) and impaired crural runoff (HR 0.16) were independent predictors of lower primary patency.
Conclusions:
- Endovascular revascularization is a reasonable strategy to avert bypass occlusion.
- Critical limb ischemia and inadequate crural runoff are significant risk factors impacting endovascular therapy success.
- Further research may optimize endovascular approaches for complex infrainguinal bypass scenarios.
Purpose:
To evaluate patency and clinical efficacy of endovascular therapy for infrainguinal bypass obstructions.
Materials And Methods:
Patients were categorized with regard to symptoms (asymptomatic/intermittent claudication [IC] vs critical limb ischemia [CLI]), bypass graft material used (autologous vs prosthetic graft), and localization of distal anastomoses (femoropopliteal vs femorodistal bypass). Primary patency was defined as absence of sonographically verified stenosis greater than 50%. Assisted primary patency was applied to secondary revisions to prevent impending occlusion. Secondary patency refers to repeat interventions aimed at restoring bypass patency after occlusion. Primary sustained clinical improvement in IC was defined as an upward shift of at least one category per Rutherford classification, accordingly to a level of claudication in patients with CLI.
Results:
A total of 54 patients (54 limbs, 12 with CLI) were included. At 1 year, primary patency rates were 74% in IC and 27% in CLI (P = .001), primary assisted patency rates were 85% in IC and 68% in CLI (P = .05), and secondary patency rates were 89% in IC and 100% in CLI (P = .32). Accordingly, primary sustained clinical improvement rates were 64% in IC and 25% in CLI (P = .018). After adjustment for confounding factors, CLI (hazard ratio [HR], 7.8; 95% CI, 2.3-26.32; P = .001) and impaired patent runoff (ie, less than three crural runoff vessels; HR, 0.16; 95% CI, 0.03-0.96; P = .045) were independently associated with impaired primary patency.
Conclusions:
Endovascular revascularization is a reasonable treatment option to prevent impending bypass occlusion. Presence of CLI and impaired crural runoff are independent risk factors for lower patency rates.