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Published on: November 19, 2019
The efficacy of salvage interventions on threatened distal bypass grafts
Sanjay Dhanji Patel1, Vassilios Zymvragoudakis1, Lisa Sheehan1
1Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Insights
Secondary interventions for threatened infrapopliteal bypass grafts successfully maintain graft patency and limb salvage. These procedures are associated with low morbidity, improving outcomes for critical limb ischemia patients.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Limb Salvage Procedures
Background:
- Infrapopliteal bypass is a key treatment for critical limb ischemia.
- Maintaining graft patency often requires secondary interventions.
- Understanding the frequency and outcomes of these interventions is crucial.
Purpose of the Study:
- To determine the frequency of secondary interventions for infrapopliteal bypass grafts.
- To evaluate the outcomes of these interventions in terms of graft patency and limb salvage.
- To compare outcomes between threatened and non-threatened grafts.
Main Methods:
- Analysis of consecutive patients undergoing infrapopliteal bypass for critical limb ischemia (Rutherford 4-6) from 2009-2013.
- Primary endpoints included graft patency, amputation-free survival (AFS), and freedom from reintervention at 12 months.
- Kaplan-Meier analysis was used to assess outcomes.
Main Results:
- 114 bypasses were performed in 102 patients.
- Secondary interventions (endovascular and surgical) were performed on 51% of grafts.
- 12-month primary patency was 57%, assisted primary patency 76%, and secondary patency 82%. AFS was 80% at 12 months.
Conclusions:
- Secondary interventions are effective in maintaining infrapopliteal bypass graft patency.
- These interventions contribute to successful limb salvage in patients with critical limb ischemia.
- Outcomes are favorable, with low morbidity rates associated with secondary interventions.
Objective:
Infrapopliteal bypass is an established and effective method for limb salvage in patients with critical limb ischemia. Secondary interventions maybe required to maintain graft patency. The aim of this study was to look at the frequency and outcomes of such interventions.
Methods:
Consecutive patients undergoing bypasses onto the infrapopliteal vessels for critical limb ischemia (Rutherford 4-6) at a single institution were analyzed between 2009 and 2013. The primary end points were graft patency, amputation-free survival (AFS), and freedom from reintervention at 12 months by Kaplan-Meier analysis.
Results:
A total of 114 infrapopliteal bypasses were performed in 102 patients. Distal anastomosis was on to the anterior tibial (n = 31), posterior tibial (n = 27), peroneal (n = 24), tibioperoneal trunk (n = 23), or dorsalis pedis artery (n = 9). Primary patency, assisted primary patency, and secondary patency was 57%, 76%, and 82%, respectively, at 12 months and 44%, 70%, and 80%, respectively, at 36 months. AFS was 80% at 12 months and 65% at 36 months. Endovascular salvage interventions were performed on 58 grafts (51%) including angioplasty of inflow/proximal anastomosis (33%), outflow/distal anastomosis (46%), and graft stenosis (20%), with a further 12 grafts (11%) undergoing thrombolysis for occlusion. Surgical salvage interventions included jump grafts (n = 7), revision of anastomotic stenosis (n = 3), and thrombectomy (n = 2). AFS was similar in salvaged threatened and acutely occluded grafts compared with nonthreatened grafts (P = .064) and better in grafts requiring reintervention later (>6 months from bypass) compared with those requiring early reintervention (<6 months; P = .047).
Conclusions:
Secondary interventions in threatened distal bypass grafts are successful at maintaining graft patency and AFS when compared with nonthreatened grafts, and are associated with a low morbidity rate.
