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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Factors associated with infrainguinal bypass graft patency at 1-year; a retrospective analysis of a single centre
Pasha Normahani1,2, Ismail Yusuf Anwar1,2, Alona Courtney1,2
1Imperial Vascular Unit, Imperial College London NHS Healthcare Trust, London, UK.
Insights
Previous ipsilateral revascularisation significantly impacts lower limb revascularisation graft patency. Identifying high-risk patients improves informed consent and peri-operative management for better outcomes.
Area of Science:
- Vascular Surgery
- Graft Patency Research
- Lower Limb Revascularisation
Background:
- Primary graft patency is crucial for successful lower limb revascularisation (LLR).
- Identifying factors influencing 1-year patency rates is essential for patient management.
Purpose of the Study:
- To identify factors associated with primary graft patency one year after open lower limb revascularisation.
- To assess the impact of patient demographics, comorbidities, and surgical strategies on LLR outcomes.
Main Methods:
- Retrospective analysis of 77 patients undergoing infra-inguinal bypass surgery.
- Data collected included demographics, comorbidities, operation type, anti-thrombotic strategy, and run-off score.
- Cox proportional hazards model used to determine significant factors.
Main Results:
- Overall 1-year primary patency rate was 63.6%.
- Factors associated with significantly inferior patency included below-knee targets, chronic limb-threatening ischaemia, and previous ipsilateral revascularisation.
- Previous ipsilateral revascularisation was the only statistically significant factor impacting primary patency (HR 2.44, p=0.04).
Conclusions:
- Previous ipsilateral revascularisation is the most significant factor affecting 1-year graft patency in LLR.
- Patients with prior revascularisation should be considered high-risk.
- Informed consent and peri-operative management should be tailored for these high-risk patients.
Introduction:
The aim of this study was to identify factors associated with primary graft patency 1 year following open lower limb revascularisation (LLR) at a tertiary referral vascular service.
Methods:
A retrospective analysis of patients undergoing infra-inguinal bypass surgery between January 2016 and May 2017 at a tertiary vascular centre (St Mary's Hospital, London) was performed. Data regarding patient demographics, comorbidities, type of operation and post-operative anti-thrombotic strategy were collected. Quality of run-off score was assessed from pre-operative imaging.
Results:
Seventy-seven cases were included in the analysis. Overall, the primary patency rate at 1-year was 63.6% (n = 49/77) and the secondary patency rate was 67.5% (n = 52/77). Independent variables with statistically significant inferior patency rates at 1-year were (1) bypasses with below knee targets (p = 0.0096), (2) chronic limb threatening ischaemia indication (p = 0.038), (3) previous ipsilateral revascularisation (p < 0.001) and (4) absence of hypertension history (p = 0.041). There was also a trend towards significance for American Society of Anesthesiologists (ASA) grade (p = 0.06). Independent variables with log-rank test p values of <0.1 were included in a Cox proportional hazards model. The only variable with a statistically significant impact on primary patency rates was previous open or endovascular ipsilateral revascularisation (HR 2.44 (1.04-5.7), p = 0.04).
Conclusion:
At 1-year follow-up, previous ipsilateral revascularisation was the most significant factor in affecting patency rates. Patients in this subgroup should therefore be deemed high-risk, which should be reflected in the informed consent and peri-operative management.
