Related Experiment Video
Updated: Jul 30, 2025
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Characteristics and Outcomes of Patients Undergoing Infrainguinal Bypass in the Endovascular Era
Randall A Bloch1, Erin E McIntosh1, Frank B Pomposelli1
1Division of Vascular and Endovascular Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA.
Insights
Despite most patients meeting high-risk criteria, lower extremity bypass (LEB) for chronic limb-threatening ischemia (CLTI) achieved outcomes comparable to Society for Vascular Surgery (SVS) objective performance goals (OPGs). This supports LEB for limb salvage in complex cases.
Area of Science:
- Vascular Surgery
- Chronic Limb-Threatening Ischemia (CLTI)
- Objective Performance Goals (OPGs)
Background:
- Society for Vascular Surgery (SVS) developed Objective Performance Goals (OPGs) for lower extremity bypass (LEB) in chronic limb-threatening ischemia (CLTI).
- Contemporary LEB patients often have prior interventions and are considered high-risk by original SVS OPG standards.
- The endovascular era has shifted patient demographics undergoing LEB.
Purpose of the Study:
- To characterize contemporary patients undergoing LEB for CLTI.
- To determine if outcomes for LEB in CLTI patients align with established SVS OPG parameters.
- To assess the efficacy of LEB in a high-risk, endovascular-era patient population.
Main Methods:
- Retrospective analysis of 169 LEBs for CLTI between 2012-2021.
- Patients stratified into low- and high-risk categories based on SVS OPG clinical, conduit, and anatomic parameters.
- Comparison of 1-year limb salvage and amputation-free survival with the SVS OPG cohort; evaluation of primary, assisted, and secondary patency rates at 1 and 3 years using Kaplan-Meier analysis.
Main Results:
- The cohort included a high proportion of patients with risk factors: 60.36% male, 59.76% smokers, 68.05% hypertension, 40.83% diabetes, 23.67% coronary artery disease.
- 69.82% had high-risk anatomic factors, 38.46% had prior endovascular intervention, and 10.65% were redo bypasses.
- 1-year freedom from amputation (87.05%) and amputation-free survival (77.78%) were comparable to the SVS OPG cohort (88.9% and 76.5%, respectively). Primary patency at 1 year was 46.84%.
Conclusions:
- The majority of patients undergoing LEB in the endovascular era meet SVS OPG high-risk criteria.
- 1-year limb salvage and amputation-free survival in this contemporary cohort were equivalent to the SVS OPG LEB cohort.
- LEB remains a viable option for limb salvage in high-risk patients, including those with failed endovascular treatments.
Background:
The Society for Vascular Surgery (SVS) developed objective performance goals (OPGs) for lower extremity bypass (LEB) in chronic limb-threatening ischemia (CLTI) based on studies that included patients who were at good risk for open revascularization. In the endovascular era, many LEB patients have had prior interventions, and most would be considered high-risk by the original SVS OPG standards. The goal of this study is to characterize a contemporary patient population undergoing LEB for CLTI and determine if outcomes remain commensurate with the parameters established by the SVS OPG.
Materials And Methods:
All patients who underwent LEB for CLTI over a 10-year period (2012-2021) were identified. Patients were stratified into low- and high-risk categories based upon the clinical, conduit, and anatomic parameters used in the SVS OPG. Limb salvage at 1 year and amputation-free survival, a composite outcome of major amputation and mortality, at 1 year were compared with the SVS OPG cohort. Primary, assisted, and secondary patency at 1 and 3 years were also evaluated using Kaplan-Meier survival analysis.
Results:
There were 169 LEBs performed for CLTI. One hundred and two (60.36%) males, 101 (59.76%) current or former smokers, 115 (68.05%) with hypertension, 69 (40.83%) with diabetes mellitus, and 40 (23.67%) with coronary artery disease. Median age was 71.84 years, and mean follow-up was 2.17 years. 65 (38.46%) had a prior ipsilateral endovascular intervention, and 18 (10.65%) were redo bypasses. 21 (12.43%) were deemed clinically high-risk, 44 (26.04%) were high-risk conduits, and 118 (69.82%) had high-risk anatomic factors. Freedom from amputation at 1 year was 87.05% in this cohort which was similar to the overall SVS OPG cohort (88.9%). Amputation-free survival at 1 year was 77.78%, which was also similar to the overall SVS OPG cohort (76.5%). Primary patency at one and three years was 46.84% and 37.59%, assisted patency at one and three years was 61.87% and 44.81%, and secondary patency at one and three years was 72.13% and 61.16%.
Conclusions:
The majority of patients undergoing LEB in the endovascular era meet the SVS OPG criteria for high risk. Despite this, the 1-year limb salvage and amputation-free survival in this cohort were equivalent to the SVS OPG LEB cohort. This supports the continued use of LEB for limb salvage in high-risk patients and those who have failed endovascular approaches.
More Related Videos
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
07:22Vein Interposition Model: A Suitable Model to Study Bypass Graft Patency
Published on: January 15, 2017
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:22Aneurysm IV: Nursing Management
01:27Peripheral Artery Disease III: Interprofessional Care