Outcomes after open infrainguinal bypass in patients with scleroderma

Area of Science:

• Vascular Surgery
• Rheumatology
• Patient Outcomes

Background:

• Limited data exists on infrainguinal bypass outcomes for scleroderma patients.
• Systemic sclerosis (scleroderma) poses unique challenges in vascular reconstruction.
• Peripheral arterial disease in scleroderma often presents as critical limb ischemia.

Purpose of the Study:

• To evaluate the long-term outcomes of infrainguinal bypass surgery in patients with systemic sclerosis.
• To compare graft failure and limb salvage rates between scleroderma and non-scleroderma patients.
• To inform clinical decision-making for revascularization in scleroderma patients.

Main Methods:

• Retrospective review of systemic sclerosis patients undergoing infrainguinal bypass (2007-2014).
• Comparison with a cohort of non-scleroderma patients undergoing similar procedures.
• Kaplan-Meier and Cox regression analyses for graft failure and limb salvage.
• Outcomes assessed per Society for Vascular Surgery standards.

Main Results:

• 12 scleroderma patients (18 grafts) with critical limb ischemia were analyzed.
• Graft failure was significantly higher in scleroderma patients (HR 7.2, P=.02).
• Limb salvage rate in scleroderma patients was 72% with a mean follow-up of 2.3 years.

Conclusions:

• Open infrainguinal bypass surgery yields significantly worse long-term outcomes in scleroderma patients.
• Careful consideration of these poorer outcomes is crucial before revascularization decisions.
• Scleroderma patients represent a high-risk group for infrainguinal bypass complications.