Cardiovascular Risk Reduction is Important for Improving Patient and Graft Survival After Ligation and Bypass Surgery
11 NIHR Leicester Cardiovascular Biomedical Research Unit, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
Insights
Ligation and bypass surgery for popliteal artery aneurysms shows 5-year survival rates around 80%. Cardiovascular risk factors like smoking and heart disease significantly impact graft patency and patient survival.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Medical Outcomes Research
Background:
- Popliteal artery aneurysms (PAA) pose a risk of limb ischemia and systemic embolization.
- Ligation and bypass (LGB) surgery is a common treatment for PAA, but outcomes and influencing factors require detailed reporting.
Purpose of the Study:
- To evaluate the outcomes of ligation and bypass (LGB) surgery for popliteal artery aneurysms (PAA).
- To identify factors influencing patient survival and graft patency after LGB surgery for PAA.
Main Methods:
- Retrospective review of 84 LGB repairs in 69 patients (1999-2012).
- Survival analyses calculated for primary graft patency (PGP), primary-assisted graft patency (PAGP), secondary graft patency (SGP), and patient survival.
- Multivariate analysis identified predictors of graft failure and patient mortality.
Main Results:
- Five-year rates: PGP 58.1%, PAGP 84.4%, SGP 85.2%, patient survival 81.1%.
- Urgency of operation and smoking predicted PGP.
- Hyperlipidemia and cerebrovascular disease (CVD) influenced graft patency.
- Previous myocardial infarction and CVD were key predictors of patient survival.
Conclusions:
- Cardiovascular risk factors, including smoking and ischemic heart disease, are critical predictors of early graft failure and mortality post-LGB surgery for PAA.
- Optimizing management of cardiovascular risk factors may improve outcomes for patients undergoing PAA repair.
Objectives:
To report outcomes following ligation and bypass (LGB) surgery for popliteal artery aneurysm (PAA) and study factors influencing patient and graft survival.
Materials And Methods:
A retrospective review of patients undergoing LGB surgery for PAA between September 1999 and August 2012 at a tertiary referral vascular unit was performed. Primary graft patency (PGP), primary-assisted graft patency (PAGP), and secondary graft patency (SGP) rates were calculated using survival analyses. Patient, graft aneurysm-free survival (GAFS), aneurysm reperfusion-free survival (ARFS), and amputation-free survival (AFS) rates were also calculated. Log-rank testing and Cox proportional hazards modeling were used to perform univariate and multivariate analysis of influencing factors, respectively.
Results:
Eighty-four LGB repairs in 69 patients (mean age 71.3 years, 68 males) were available for study. The 5-year PGP, PAGP, SGP, and patient survival rates were 58.1%, 84.4%, 85.2%, and 81.1%, respectively. On multivariate analysis, the principal determinants of PGP were urgency of operation ( P = .009) and smoking status ( P = .019). The principal determinants of PAGP were hyperlipidemia status ( P = .048) and of SGP were hyperlipidemia ( P = .042) and cerebrovascular disease (CVD) status ( P = .045). The principal determinants of patient survival were previous myocardial infarction ( P = .004) and CVD ( P = .001). The 5-year GAFS, ARFS, and AFS rates were 87.9%, 91.6%, and 96.1%, respectively.
Conclusion:
This study has shown that traditional cardiovascular risk factors, such as a smoking and ischemic heart disease, are the most important predictors of early graft failure and patient death following LGB surgery for PAA.
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