Surgical infrainguinal revascularization for peripheral arterial disease: factors affecting patency rate
Ali Jafarian1, Fezzeh Elyasinia2, Mohammad Reza Keramati3
1Associate Professor of Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran. jafarian@tums.ac.ir.
Insights
Surgical infrainguinal reconstruction outcomes show variable graft patency, with risk factors like diabetes and hypertension significantly decreasing success rates over one year.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Regenerative Medicine
Background:
- Peripheral arterial disease (PAD) is a significant cause of patient morbidity and mortality.
- Surgical vascular reconstruction is a treatment for PAD, but graft failure and complications are concerns.
- This study investigates the outcomes of surgical infrainguinal reconstruction and factors influencing graft patency.
Purpose of the Study:
- To evaluate the one-year outcome of surgical infrainguinal reconstruction.
- To identify factors affecting graft patency after lower extremity vascular reconstruction.
Main Methods:
- A cohort study included 85 patients with chronic ischemia undergoing infrainguinal reconstruction (femoropopliteal and femorofemoral bypass).
- Graft patency was assessed using duplex ultrasonography before discharge and one year post-surgery.
- The association between potential risk factors and graft patency was analyzed.
Main Results:
- One-year patency rates were 71% for femoropopliteal and 52% for femorofemoral reconstructions.
- Diabetes mellitus, hypertension, smoking, opium use, and ischemic heart disease were significantly linked to reduced graft patency (p<0.05).
Conclusions:
- Identifying risk factors for perioperative mortality and graft patency is crucial for patient selection in surgical reconstruction.
- Endovascular intervention or omitting surgery may be preferable for patients with multiple risk factors or without critical limb ischemia.
Background:
Peripheral arterial disease is a source of morbidity and mortality. Surgical vascular reconstruction is a treatment option but probability of failure and complications are important concerns. In this study, we evaluated outcome of surgical infrainguinal reconstruction and factors affecting graft patency for a period of one year.
Methods:
In this cohort study, 85 consecutive patients with chronic ischemia who underwent lower extremity surgical vascular reconstruction (including 52 femoropopliteal and 25 femorofemoral bypass) from March 2007 to Feb 2009 were recruited. Graft patency was evaluated before discharge from hospital and one year after the surgical operation using duplex ultrasonography. Association between possible risk factors and graft patency were evaluated.
Results:
In general, 71% (37 patients) of femoropopliteal and 52% (13 patients) of femorofemoral reconstructions were patent during the follow up period. Diabetes mellitus, hypertension, smoking, opium use and ischemic heart disease were significantly associated with decreased rate of patency (p<0.05).
Conclusion:
Assessing risk factors that predict perioperative mortality and graft patency is essential for selecting patients that would benefit from surgery. Omitting surgical reconstruction and endovascular intervention may be preferable especially when multiple risk factors are present or in the absence of critical limb ischemia.
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