Prosthetic versus native artery inflow for infrainguinal bypass.

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Arterial Bypass Procedures

Background:

• Infrainguinal bypass after previous prosthetic inflow reconstruction presents a choice for proximal anastomosis: the previous bypass hood or a distal native artery.
• While the bypass hood may be technically easier to access, the native artery might offer superior long-term patency for outflow revascularization.

Purpose of the Study:

• To compare the outcomes of infrainguinal bypass procedures based on the inflow source: the hood of a prior prosthetic bypass versus a distal native artery.

Main Methods:

• A retrospective analysis of 197 infrainguinal bypass cases performed between 2006 and 2016 after a previous prosthetic inflow bypass.
• Patients were divided into two groups: those using the previous bypass hood (prosthetic group) and those using a distal native artery (native group) for inflow.
• Kaplan-Meier method was used to calculate patency rates, with a subset analysis for cases where the inflow bypass had occluded.

Main Results:

• The native artery group (138 patients) showed significantly greater 1-year patency (91%) compared to the prosthetic group (59 patients, 75%; P = .0221).
• In cases of inflow bypass occlusion, the native artery group maintained significantly better 1-year patency (87%) than the prosthetic group (40%; P = .0035).
• Demographics and indications for surgery were similar between the groups.

Conclusions:

• Using the distal native artery as the inflow source for infrainguinal bypass after a previous prosthetic inflow procedure results in superior graft patency.
• The native artery inflow option provides continued patency even if the original inflow bypass occludes, highlighting its long-term reliability.