Descriptive Analysis of Amputation-Free Survival After First Time Infra-Inguinal Bypass Occlusion

Area of Science:

• Vascular Surgery
• Peripheral Artery Disease Management
• Graft Patency and Limb Salvage

Background:

• Infra-inguinal bypass occlusion is a severe complication in peripheral artery disease treatment.
• Understanding the natural history and predictors of outcomes after bypass occlusion is crucial for limb salvage.

Purpose of the Study:

• To describe the natural history of graft occlusion after first-time infra-inguinal bypass.
• To identify factors associated with long-term major amputation-free survival following bypass occlusion.

Main Methods:

• Retrospective cohort study of patients with peripheral artery disease undergoing first-time infra-inguinal bypass with subsequent graft occlusion.
• Analysis of a prospective database from a tertiary care vascular center (1997-2021).
• Cox proportional hazard models used to determine predictors of major amputation-free survival.

Main Results:

• 255 bypass occlusions were analyzed from 1318 infra-inguinal bypass surgeries.
• Major amputation-free survival at 1, 5, and 10 years post-occlusion was 56.9%, 37.1%, and 17.2%, respectively.
• Factors associated with lower survival included older age, female sex, comorbidities, chronic limb-threatening ischemia, and distal bypass outflow; new bypass or graft salvage improved survival.

Conclusions:

• Long-term major amputation-free survival after infra-inguinal bypass occlusion is poor.
• Nonmodifiable risk factors negatively impact survival, but revascularization strategies (new bypass or graft salvage) can improve outcomes.