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Vein Interposition Model: A Suitable Model to Study Bypass Graft Patency
Published on: January 15, 2017
Impact of inflow reconstruction on infrainguinal bypass
M J Eagleton1, K A Illig, R M Green
1Department of Surgery, University of Rochester Medical Center, NY 14642, USA.
Insights
Multisegmental disease requiring inflow procedures in infrainguinal bypass grafting may lower primary patency rates, but limb salvage and survival remain unaffected. Patient surveillance is recommended to monitor inflow disease progression.
Area of Science:
- Vascular Surgery
- Graft Patency Analysis
- Peripheral Artery Disease
Background:
- Infrainguinal bypass grafting is crucial for limb salvage in patients with peripheral artery disease.
- Multisegmental disease may necessitate inflow procedures, potentially impacting graft outcomes.
- Understanding the effect of inflow source on bypass success is vital for surgical decision-making.
Purpose of the Study:
- To evaluate if severe multisegmental disease requiring inflow procedures affects infrainguinal bypass graft patency, limb salvage, and patient survival.
- To compare outcomes between grafts with reconstructed vs. normal inflow sources.
Main Methods:
- Retrospective review of 551 infrainguinal bypass grafts in 495 patients.
- Separate analysis of saphenous vein and prosthetic grafts.
- Comparison of graft patency, limb salvage, and survival rates based on inflow source (reconstructed vs. normal).
- Identification of graft failure causes.
Main Results:
- Vein grafts from reconstructed inflow had lower 4-year primary patency (41% vs 54%; p=0.006), but similar assisted and secondary patency.
- Prosthetic graft patency rates were not significantly different based on inflow source.
- Inflow failure was a common cause of occlusion, particularly in grafts with multisegmental disease (24% vein, 22% prosthetic).
- Inflow procedures did not impact limb salvage or survival rates.
Conclusions:
- Reconstructed inflow sources do not adversely affect long-term infrainguinal bypass outcomes, limb salvage, or survival.
- Inflow failure is a significant cause of occlusion in patients with multisegmental disease.
- Enhanced patient surveillance for inflow disease progression is recommended for these high-risk patients to enable timely intervention and prevent graft occlusion.
Purpose:
This study assessed whether multisegmental disease that is severe enough to require an inflow procedure adversely affects infrainguinal bypass patency, limb salvage, or patient survival rates.
Methods:
The records of 495 patients who underwent 551 infrainguinal bypass grafting procedures were reviewed. Saphenous vein and prosthetic grafts were evaluated separately. Graft patency rates, patient limb salvage rates, and patient survival rates in those grafts that arose from a reconstructed inflow source were compared with those that arose from normal, nonreconstructed inflow sources. When grafts had either hemodynamic failure or occlusion, the cause of failure was identified.
Results:
Four-year primary patency rates in vein grafts that arose from a reconstructed inflow sources were lower than those in grafts that arose from nonreconstructed inflow sources (41% vs 54%; p = 0.006). Assisted primary patency rates and secondary patency rates, however, were similar (62% vs 74% and 64% vs 77%, respectively). The 4-year primary patency rate (45% vs 55%), assisted primary patency rate (60% vs 60%), and secondary patency rate (60% vs 61%) in prosthetic grafts did not vary based on inflow source. The most common cause of graft failure was inflow failure, except in the vein grafts that did not require an inflow procedure, in which the most common cause of failure was graft failure. Inflow failure occurred in 24% and 22% of the vein and prosthetic grafts with multisegmental disease, respectively, but in only 7% (p < 0.001) and 10% (p < 0.05), respectively, of those that arose from normal nonreconstructed inflow. The presence of an inflow procedure did not affect limb salvage rates or patient survival rates, regardless of graft material.
Conclusions:
Long-term patency rates, patient limb salvage rates, and survival rates in patients with a reconstructed inflow source were similar to those of patients with a normal nonreconstructed inflow. A major cause of occlusion is inflow failure, and this occurs in a greater proportion of patients with multisegmental disease. These patients, in particular, may benefit from patient surveillance to screen for progression of their inflow disease and to allow for intervention before infrainguinal graft occlusion.
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