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Perioperative noninvasive hemodynamic ankle indices as predictors of infrainguinal graft patency
Insights
Preoperative ankle/brachial pressure index (ABPI) and ankle pulse volume recording amplitude (APVR) predict early femorotibial bypass closure. Lower preoperative ABPI or APVR values indicate a higher risk of graft failure.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
- Graft Patency
Background:
- Femoropopliteal and femorotibial bypasses are critical interventions for peripheral artery disease.
- Graft closure remains a significant challenge, impacting long-term limb salvage.
- Predictive markers for graft failure are essential for optimizing patient selection and outcomes.
Purpose of the Study:
- To evaluate the predictive value of preoperative and postoperative ankle/brachial pressure index (ABPI) and ankle pulse volume recording amplitude (APVR) for femoropopliteal and femorotibial bypass graft patency.
- To identify factors associated with early and late graft closure.
Main Methods:
- Retrospective analysis of 129 femoropopliteal and 141 femorotibial bypasses.
- Assessment of pre- and postoperative ABPI and APVR, including their changes (delta).
- Correlation of these indices with early (<1 month) and late graft closure rates.
Main Results:
- Preoperative ABPI < 0.2 or APVR < 5 mm significantly increased the risk of early femorotibial bypass closure (37% vs. 19% for ABPI, 34% vs. 15% for APVR).
- Limbs with favorable preoperative ABPI (>0.2) and APVR (>5 mm) had a lower occlusion rate (25%) compared to those with unfavorable indices (51%).
- Neither preoperative nor postoperative indices or their delta predicted femoropopliteal bypass closure or late femorotibial bypass closure.
Conclusions:
- Preoperative ABPI and APVR are valuable predictors of early femorotibial bypass failure, guiding risk stratification.
- Despite higher early failure rates, femorotibial bypasses in high-risk patients maintain a 39% patency at 24 months.
- Femoropopliteal bypass outcomes were not reliably predicted by the assessed hemodynamic parameters.
Abstract:
Of 129 femoropopliteal bypasses, 40 closed in 0 to 42 months. Early and late closures were not predicted by pre- or postoperative ankle/brachial pressure index (ABPI) or ankle pulse volume recording amplitude (APVR) or their increments (delta). Of 141 femorotibial bypasses, 60 closed in 0 to 12 months, with 46 closing early (less than 1 month). Early failure occurred in 19 of 52 limbs (37%) with pre-ABPI less than 0.2 and 17 of 89 limbs (19%) with pre-ABPI greater than 0.2 (p less than 0.025). Similar significant differences in early patency occurred between limbs with pre-APVR less than 5 and greater than 5 mm (29 of 94 [34%] vs. 7 of 47 [15%], respectively). Late closure was not predicted by either value. Thus in the 44 limbs with pre-ABPI greater than 0.2 and pre-APVR greater than 5 mm, only 11 grafts closed (25%), whereas if pre-ABPI was less than 0.2 or pre-APVR less than 5 mm, 49 of 97 grafts (51%) occluded within 17 months (p less than 0.025). Postoperative or delta indices had no predictive value. Preoperative ABPI less than 0.2 or APVR less than 5 mm was associated with twice the risk of early femorotibial graft closure; however, cumulative life-table patency was still 39% at 24 months.