Post-operative transfusion is associated with infrainguinal bypass graft failure: contemporary Australian tertiary...

Peripheral arterial disease (PAD) is an increasingly prevalent and highly morbid pathology affecting the older population. Infra-inguinal bypass (IIB) surgery remains a robust revascularization option in these patients. This study aimed to identify modifiable predictors associated with graft patency and functional outcomes in contemporary Australian vascular surgical practice.

A retrospective analysis of patients undergoing IIB between 2010 and 2020 at a tertiary vascular surgery centre in Australia was performed. Data regarding patient demographics, co-morbidities, pre-operative investigations, bypass characteristics, and discharge outcomes were collected. Surveillance ultrasound scans were reviewed to gain information on graft patency and compliance up to 2 years post-operatively. The primary outcome was graft failure. Secondary outcomes were mobility status and amputation-free survival at 1 year.

A total of 239 IIBs were performed on 207 patients during the 10-year period. Significant predictors for primary graft occlusion included regional referral (P < 0.01), low pre-operative haemoglobin level (P < 0.01), post-operative transfusion requirement (P = 0.02), use of prosthetic conduit (P < 0.01) and non-compliance to ultrasound surveillance (P < 0.01). Patients with a thrombosed graft were 2.4 times more likely to experience deterioration in mobility status (P < 0.01) and 8.6 times more likely to have major limb amputation or death at 1 year. The amputation-free survival was 88.3% at 1 year.

Optimization of pre-operative haemoglobin level for IIB should be advocated in clinical practice in order to reduce the risk of graft failure, deterioration in ambulatory function, major limb amputation and mortality.