Midterm Results of Precuffed Grafts in Lower Limb Bypass Surgeries

Background Prosthetic grafts have been used for lower limb bypass surgery when the long saphenous vein option is not available; however, they showed suboptimal outcomes, especially when used below the knee. The use of precuffed grafts has emerged as a potential solution to address some of the limitations associated with traditional graft choices. Materials and methods All patients who underwent bypass surgery using precuffed grafts in Manchester Royal Infirmary between March 2020 and August 2023 were included in the retrospective analysis. The primary outcome was amputation-free survival over one month, 12 months, and 24 months. Secondary outcomes were mortality rate, patency rate, and postoperative complications. Results A total of 87 patients were included in this study; 47.1% of patients achieved the primary outcome endpoint by the end of 24 months. Smoking (hazard ratio {HR} 4.103, CI 1.417-11.881, p=0.009), female sex (HR 0.304, CI 0.119-0.774, p=0.013), and presence of tissue loss (HR 0.217, CI 0.086-0.55, p=0.001) were independent statistically significant predictors of poor primary outcome of precuffed grafts. The mortality rate was 20.7% at 24 months, with cardiac disease as predictive of a higher mortality rate; the patency rate was 41.4% at 24 months. The following were negative predictors for graft patency: smoking, female sex, and presence of tissue loss. Conclusion While the long saphenous vein remains the preferred choice for bypass, our study demonstrates that precuffed grafts are a valid alternative when the long saphenous vein is unavailable. These grafts show an acceptable amputation-free survival rate over a two-year follow-up period.