Comparison of procedural outcomes after lower extremity reversed vein grafting and secondary surgical revision

Objective: Many lower extremity vein graft procedures require revision. Although morbidity associated with revision procedures is assumed minimal, this has not been previously quantified and may be underestimated. In this study, patient outcome after initial vein graft procedures and revisions are compared. Methods: Records for all patients undergoing vein graft revision from January 1995 to August 2002 were reviewed for operation time, estimated blood loss, blood transfusion, hospital length of stay, perioperative complications, and functional status at discharge and at 2-month follow-up. Revisions were compared with the original operation and by revision type. Results: One hundred sixty-five vein graft revisions were performed in 137 patients. In comparison with the initial bypass procedure, mean operation time (3.35 ± 1.41 hours vs 2.58 ± 1.04 hours; P < .001), estimated blood loss (272.4 ± 249.9 mL vs 174.8 ± 140.8 mL; P < .001), hospital length of stay (10.15 ± 4.85 days vs 7.05 ± 5.14; P < .001), and overall complication rate (35.8% vs 22.4%; P = .015) were significantly less for revision procedures. Revision of more than one site on the graft resulted in longer operation time (P = .003) and estimated blood loss (P < .001), but similar complication rates (P = NS), compared with revision at only one site. Revisions that involved only the graft resulted in decreased hospital length of stay compared with revisions involving extension to native inflow or outflow vessels (P < .02). Return to preoperative ambulatory status at discharge was 71% after initial operation, and was 92% after revision (P < .001). Return to independent living at discharge was 66% after the initial operation, and was 80% after revision (P < .01). Conclusions: Operative revisions were better tolerated than initial vein graft procedures, but are still major procedures. Hospital length of stay is longer for patients undergoing proximal or distal extension of the graft to native vessels and in patients who are not ambulatory and living independently at discharge. Patients undergoing vein graft revision should be counseled about potential morbidity.