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Limb outcomes based on limb severity and anatomic complexity following infrapopliteal vein bypass for Japanese

Taira Kobayashi1, Masaki Hamamoto1, Takanobu Okazaki1

  • 1Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.

Journal of Vascular Surgery
|January 7, 2023
PubMed

Insights

Limb salvage and wound healing after infrapopliteal vein bypass depend on limb severity (WIfI stage), not anatomic complexity (GLASS stage). Patients with advanced WIfI stage 4 had poorer outcomes, highlighting the need for tailored management.

Area of Science:

  • Vascular Surgery
  • Limb Revascularization
  • Clinical Outcomes

Background:

  • The 2019 Global Vascular Guidelines recommend revascularization strategies based on limb severity (WIfI stage) and anatomic complexity (GLASS stage).
  • Limited data exist on limb outcomes following infrapopliteal vein bypass stratified by WIfI and GLASS stages.

Purpose of the Study:

  • To evaluate limb outcomes after infrapopliteal vein bypass in relation to WIfI and GLASS staging.
  • To assess limb salvage, amputation rates, wound healing, and healing time based on these classifications.

Main Methods:

  • Retrospective analysis of 353 infrapopliteal vein bypasses in 284 patients with chronic limb-threatening ischemia.
  • Comparison of medium-term limb outcomes, including limb salvage rate, major to minor amputation ratio, wound healing rate, and wound healing time, across WIfI and GLASS stages.

Main Results:

  • The 3-year limb salvage rate was 87%, significantly lower in WIfI stage 4 compared to stage 2.
  • Wound healing rate at 12 months was 86%, also significantly lower in WIfI stage 4 versus stages 2 and 3.
  • Wound healing time was significantly longer in WIfI stage 4 compared to stages 2 and 3; no significant differences were observed across GLASS stages for any outcome.

Conclusions:

  • Limb outcomes after infrapopliteal vein bypass are significantly associated with limb severity (WIfI stage).
  • Anatomic complexity (GLASS stage) did not show a significant association with limb outcomes in this cohort.
  • Preoperative strategy and perioperative management should be tailored to patients with greater limb severity (higher WIfI stage).
Abstract

Keywords:
Global Vascular Guidelines (GVGs)Infrapopliteal vein bypassLimb salvageWound healingWound, ischemia, and foot infection (WIfI)

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