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Supra-Inguinal Inflow for Distal Bypasses Have Acceptable Patency and Limb Salvage Rates.

Molly Ratner1, Heepeel Chang2, William Johnson1

  • 1Department of Surgery, Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA.

Annals of Vascular Surgery
|June 28, 2024
PubMed
Summary
This summary is machine-generated.

Lower extremity bypass (LEB) using supra-inguinal inflow shows acceptable outcomes for high-risk patients. Tibial bypasses had worse primary patency, but amputation-free survival and limb salvage remained comparable.

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Area of Science:

  • Vascular Surgery
  • Reconstructive Surgery
  • Limb Salvage Procedures

Background:

  • Limited data exists on lower extremity bypass (LEB) outcomes using supra-inguinal inflow for infra-inguinal vessel revascularization.
  • This study evaluates outcomes of LEB from aortoiliac arteries to infra-femoral targets.

Purpose of the Study:

  • To report outcomes after lower extremity bypass (LEB) originating from aortoiliac arteries to infra-femoral targets.
  • To compare perioperative and 1-year outcomes based on outflow targets: above-knee popliteal, below-knee popliteal, and tibial arteries.

Main Methods:

  • Analysis of the Vascular Quality Initiative database (2003-2020) for patients undergoing LEB.
  • Stratification into three cohorts based on outflow targets (above-knee popliteal, below-knee popliteal, tibial arteries).
  • Comparison of primary patency, amputation-free survival (AFS), and major adverse limb events (MALEs); Cox proportional hazards model used for prognostic factors.

Main Results:

  • 389 of 403 LEBs used external iliac artery inflow; 116 (28.8%) targeted above-knee popliteal, 151 (27.5%) below-knee popliteal, and 136 (43.7%) tibial arteries.
  • Below-knee popliteal and tibial bypasses were more common in chronic limb-threatening ischemia patients and used vein conduit more frequently.
  • Perioperative reoperation rates and 1-year primary patency were lower for below-knee popliteal and tibial bypasses compared to above-knee popliteal.
  • Tibial bypasses were independently associated with increased loss of primary patency (HR 1.9, P=0.04).

Conclusions:

  • Lower extremity bypass with supra-inguinal inflow demonstrates acceptable 1-year patency and limb salvage rates in high-risk patients.
  • Tibial outflow targets are linked to worse primary patency but do not significantly impact MALE or AFS.
  • Above-knee popliteal bypasses showed superior primary patency in patients with chronic limb-threatening ischemia.