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Bypass Surgery after Endovascular Therapy for Infrapopliteal Lesion Is Not a Poor Outcome Compared with Initial

Koichi Morisaki1, Terutoshi Yamaoka1, Kazuomi Iwasa1

  • 1Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.

Annals of Vascular Surgery
|June 26, 2017
PubMed

Insights

Bypass surgery after endovascular therapy (EVT) shows lower primary graft patency. However, limb salvage and survival rates remain unaffected by prior EVT in critical limb ischemia patients.

Area of Science:

  • Vascular Surgery
  • Endovascular Therapy
  • Critical Limb Ischemia

Background:

  • Prior endovascular therapy (EVT) impact on subsequent bypass surgery outcomes is unclear.
  • Investigating treatment outcomes comparing bypass-first versus EVT-first strategies is crucial for critical limb ischemia (CLI) management.

Purpose of the Study:

  • To compare outcomes of bypass surgery performed initially versus after prior EVT in CLI patients.
  • To evaluate graft patency, limb salvage (LS), amputation-free survival (AFS), and overall survival (OS) between bypass-first and EVT-first groups.

Main Methods:

  • Retrospective analysis of 75 patients (82 limbs) in bypass-first group and 24 patients (24 limbs) in EVT-first group undergoing infrapopliteal bypass (Nov 2006-Dec 2015).
  • Comparison of primary patency, secondary patency, LS, AFS, and OS between the two groups.

Main Results:

  • The EVT-first group had higher average age and a greater percentage of inframalleolar bypasses.
  • Primary patency at 1 and 2 years was significantly lower in the EVT-first group (53.1%/47.2%) compared to the bypass-first group (72.0%/67.5%).
  • Inframalleolar bypass was identified as a risk factor for lower primary patency; however, no significant differences were observed in secondary patency, LS, AFS, or OS.

Conclusions:

  • Bypass surgery following EVT demonstrates reduced primary patency rates compared to primary bypass for infrapopliteal revascularization.
  • Despite limitations and heterogeneity, previous EVT did not adversely affect limb salvage, overall survival, or amputation-free survival.
Abstract

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