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Redo infrainguinal bypass: factors predicting patency and limb salvage. Ann Vasc Surg 2003 Sep;17(5):492-502

Date

09/06/2003

Pubmed ID

12958672

DOI

10.1007/s10016-003-0040-z

Scopus ID

2-s2.0-0242458197   21 Citations

Abstract

The increased complexity of redo infrainguinal bypass procedures can result in prolonged operative time and increased morbidity. This review was undertaken to compare outcomes from primary and redo bypass procedures and to identify factors predictive of graft failure and limb loss after redo bypass. All infrainguinal bypasses ( n = 468) from 1995 to 1999 were reviewed. A total of 367 primary bypasses in 317 patients were compared to 101 redo grafts in 84 patients with previously failed bypasses. Risk factors and types of procedures were compared using Student's t-test and the chi(2) test. Patency and limb salvage were compared using life-table analysis. Patients requiring redo bypasses were less likely to have diabetes and end-stage renal disease. Two-year patency (66 +/- 4% primary vs. 55 +/- 7% redo, p = 0.13) and limb salvage (75 +/- 3% primary vs. 72 +/- 6% secondary, p = 0.43) were comparable between primary and redo bypass groups. Female gender was predictive of redo graft failure (2-year patency 73 +/- 8% male vs. 39 +/- 9% female, p = 0.01). Clinical indications that predicted failure of a redo bypass included thrombosis of an autologous graft (1-year patency 71 +/- 7% previous prosthetic vs. 49 +/- 10% previous autologous, p = 0.004), thrombosis of an infrageniculate bypass (2-year patency 65 +/- 10% suprageniculate vs. 46 +/- 9% infrageniculate, p = 0.044), and a limb salvage indication for the primary operation (2-year patency 86 +/- 9% claudication vs. 44 +/- 8% limb salvage, p = 0.008). When a primary bypass fails despite the use of optimal conduit (autologous vein) and an infrageniculate target vessel, the redo bypass has a higher risk of failure, particularly in female patients. Nonetheless, patency and limb salvage rates justify an attempt at revascularization after failed primary bypass.

Author List

Rossi PJ, Skelly CL, Meyerson SL, Bassiouny HS, Katz D, Schwartz LB, McKinsey JF, Gewertz BL, Desai TR

Author

Peter J. Rossi MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Blood Vessel Prosthesis Implantation
Female
Humans
Limb Salvage
Male
Middle Aged
Predictive Value of Tests
Reoperation
Sex Factors
Survival Analysis
Treatment Outcome
Vascular Patency
jenkins-FCD Prod-478 d1509cf07a111124a2d122fd3df854cc0b993c00