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Methods for Acute and Subacute Murine Hindlimb Ischemia
Published on: June 21, 2016
Results of Infrainguinal Bypass in Acute Limb Ischaemia
P Marqués de Marino1, I Martínez López1, S Revuelta Suero1
1Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, C/ Martín Lagos s/n, 28040 Madrid, Spain.
Insights
Patients undergoing infrainguinal bypass for acute limb ischaemia face higher early risks of amputation and death. Female sex, prosthetic conduits, distal thrombectomy, and poor runoff are associated with worse outcomes in this group.
Area of Science:
- Vascular Surgery
- Limb Ischaemia Management
- Bypass Grafting Outcomes
Background:
- Infrainguinal bypass is a critical intervention for lower extremity ischaemia.
- Acute limb ischaemia (ALI) represents a surgical emergency with significant morbidity and mortality.
- Comparative outcomes between ALI and chronic lower extremity ischaemia (CLEI) require detailed analysis.
Purpose of the Study:
- To evaluate the outcomes of infrainguinal bypass surgery in patients with ALI.
- To identify predictors of graft patency, mortality, and amputation following infrainguinal bypass for ALI.
- To compare outcomes between ALI and CLEI patient cohorts.
Main Methods:
- Retrospective cohort study of 702 infrainguinal bypasses (1998-2014).
- Patients stratified into Group A (ALI) and Group B (CLEI).
- Comparative analysis of comorbidities, surgical techniques, and outcomes; prognostic factors for ALI analyzed.
Main Results:
- ALI patients (n=107) differed in age, diabetes, renal insufficiency, stroke, and CAD compared to CLEI (n=595).
- No significant difference in primary, assisted primary, or secondary patency rates between groups at 1, 12, and 24 months.
- ALI was an independent risk factor for 30-day amputation (OR 4.96) and mortality (OR 4.13); female sex, prosthetic conduit, distal thrombectomy, and poor runoff predicted worse outcomes in ALI patients.
Conclusions:
- Patients with ALI undergoing infrainguinal bypass represent a high-risk subset with increased early amputation and mortality rates.
- Predictors of poorer outcomes in ALI patients include female sex, prosthetic conduits, need for distal thrombectomy, and poor intra-operative runoff.
- Risk stratification and tailored surgical approaches are crucial for improving outcomes in ALI patients.
Objective/Background:
To assess the outcomes of infrainguinal bypass performed for acute limb ischaemia, as well as the predictors of patency, mortality, and amputation.
Methods:
This was a retrospective cohort study of patients undergoing infrainguinal bypass between 1998 and 2014. The cohort was stratified according to the indication for surgery into two groups: group A (acute limb ischaemia) and group B (chronic lower extremity ischaemia). Comparative analysis was performed on comorbidities, surgical technique, and outcomes, as well as prognostic factors in group A.
Results:
In total, 702 bypasses were performed (group A, n = 107; group B, n = 595). Differences between groups were detected in age (65.9 vs. 70.9 years; p = .03), diabetes (16% vs. 49%; p < .01), renal insufficiency (6% vs. 13%; p = .05), stroke (7% vs. 14%; p = .04), and coronary artery disease (13% vs. 28%; p < .01). Patients with acute limb ischaemia more often required general anaesthesia (47% vs. 12%; p < .01) and a short bypass was more often performed (32% vs. 7%; p < .01). Median follow up was 23 and 24 months for groups A and B, respectively. No differences were found in patency rates at 1, 12, and 24 months between groups, but group B had a higher re-intervention rate during follow up. Primary patency in group A was 84%, 63%, and 58%, and in group B it was 88%, 62%, and 53% at 1, 12, and 24 months, respectively (p = .77). Assisted primary patency in group A was 85%, 72%, and 67%, and in group B it was 90%, 74%, and 66% at 1, 12, and 24 months, respectively (p = .61). Secondary patency in group A was 90%, 78%, and 75%, and in group B it was 94%, 80%, and 74% at 1, 12, and 24 months, respectively (p = .80). The freedom from re-intervention rate in group A was 91%, 74%, and 68%, and in group B it was 92%, 76%, and 71%, respectively (p = .04). Acute limb ischaemia was an independent risk factor for amputation (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.74-14.09; p < .01) and mortality (OR 4.13, 95% CI 1.53-11.14; p = .01) at 30 days. In group A, female sex, prosthetic conduit, and need of distal thrombectomy were independently associated with worse patency rates. Poor intra-operative runoff was correlated with higher amputation rates.
Conclusion:
Among those undergoing infrainguinal bypass, patients who present with acute limb ischaemia constitute a subset showing higher early rates of amputation and death. In this subset of patients, worse outcomes may be expected for women, prosthetic conduits, need for distal thrombectomy, and patients with poor intra-operative runoff.
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