Lower extremity autologous vein bypass for critical limb ischemia is not adversely affected by prior endovascular procedure

Vincent J. Santo, Phong Dargon, Amir Azarbal, Timothy Liem, Erica Mitchell, Gregory Landry, Gregory (Greg) Moneta

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25 Citations (Scopus)

Abstract

Objective It has been reported that a failed endovascular intervention adversely affects results of lower extremity bypass (LEB). We reviewed rates of prior endovascular intervention (PEI) in patients undergoing LEB with autologous vein for critical limb ischemia (CLI) to determine effects on graft patency, limb salvage, and amputation-free survival. Methods Retrospective review was conducted of consecutive autologous vein LEBs performed for CLI between 2005 and 2012 at a tertiary care academic medical center. Results Overall, 314 autologous vein LEBs were performed for CLI, 71% for tissue loss. TransAtlantic Inter-Society Consensus II type D or type C lesions were present in 62% and 25%, respectively. The great saphenous vein was used as a conduit in 83%, and the distal target was infrapopliteal in 60%. The 30-day mortality rate was 3.5%. Primary patency rates at 1 year and 5 years were 61% and 45%. Secondary patency rates at 1 year and 5 years were 88% and 64%, with 23% requiring an intervention to maintain patency. The 5-year limb salvage rate was 89%, and the 5-year amputation-free survival was 49%. There were 61 patients (19%) who had undergone a PEI and 253 (81%) who underwent bypass with no prior endovascular intervention (NPEI). There were 19 iliac stents, 29 femoral interventions, 13 popliteal interventions, 9 crural interventions, 9 infrainguinal thrombectomies, and 13 infrainguinal thrombolyses. PEI and NPEI patients had similar demographics and prevalence of atherosclerotic risk factors. The 1-year primary patency rate was 62% for NPEI patients vs 59% for PEI patients (P =.759). The 1-year and 2-year secondary patency rates were 87% and 79% for NPEI patients vs 89% and 78% for PEI patients (P =.947). The 3-year limb salvage rate was 89% for NPEI patients vs 92% for PEI patients (P =.445). The 3-year amputation-free survival was 59% for NPEI patients vs 52% for PEI patients (P =.399). Median follow-up time was 323 days for NPEI patients (interquartile range, 83-918) vs 463 days for PEI patients (interquartile range, 145-946; P =.275). Conclusions Overall operative mortality, patency rates, and limb salvage for autologous vein LEB in CLI patients continue to be excellent in the endovascular era and are not necessarily affected by a prior ipsilateral endovascular procedure. Long-term survival remains poor in CLI patients requiring LEB.

Original languageEnglish (US)
Pages (from-to)129-135
Number of pages7
JournalJournal of Vascular Surgery
Volume60
Issue number1
DOIs
StatePublished - 2014

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Endovascular Procedures
Lower Extremity
Veins
Ischemia
Extremities
Limb Salvage
Amputation
Survival
Dilatation and Curettage
Thrombectomy
Mortality
Saphenous Vein
Tertiary Healthcare
Thigh

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

@article{327ef17698724a1aadfdd085bd3d61fe,
title = "Lower extremity autologous vein bypass for critical limb ischemia is not adversely affected by prior endovascular procedure",
abstract = "Objective It has been reported that a failed endovascular intervention adversely affects results of lower extremity bypass (LEB). We reviewed rates of prior endovascular intervention (PEI) in patients undergoing LEB with autologous vein for critical limb ischemia (CLI) to determine effects on graft patency, limb salvage, and amputation-free survival. Methods Retrospective review was conducted of consecutive autologous vein LEBs performed for CLI between 2005 and 2012 at a tertiary care academic medical center. Results Overall, 314 autologous vein LEBs were performed for CLI, 71{\%} for tissue loss. TransAtlantic Inter-Society Consensus II type D or type C lesions were present in 62{\%} and 25{\%}, respectively. The great saphenous vein was used as a conduit in 83{\%}, and the distal target was infrapopliteal in 60{\%}. The 30-day mortality rate was 3.5{\%}. Primary patency rates at 1 year and 5 years were 61{\%} and 45{\%}. Secondary patency rates at 1 year and 5 years were 88{\%} and 64{\%}, with 23{\%} requiring an intervention to maintain patency. The 5-year limb salvage rate was 89{\%}, and the 5-year amputation-free survival was 49{\%}. There were 61 patients (19{\%}) who had undergone a PEI and 253 (81{\%}) who underwent bypass with no prior endovascular intervention (NPEI). There were 19 iliac stents, 29 femoral interventions, 13 popliteal interventions, 9 crural interventions, 9 infrainguinal thrombectomies, and 13 infrainguinal thrombolyses. PEI and NPEI patients had similar demographics and prevalence of atherosclerotic risk factors. The 1-year primary patency rate was 62{\%} for NPEI patients vs 59{\%} for PEI patients (P =.759). The 1-year and 2-year secondary patency rates were 87{\%} and 79{\%} for NPEI patients vs 89{\%} and 78{\%} for PEI patients (P =.947). The 3-year limb salvage rate was 89{\%} for NPEI patients vs 92{\%} for PEI patients (P =.445). The 3-year amputation-free survival was 59{\%} for NPEI patients vs 52{\%} for PEI patients (P =.399). Median follow-up time was 323 days for NPEI patients (interquartile range, 83-918) vs 463 days for PEI patients (interquartile range, 145-946; P =.275). Conclusions Overall operative mortality, patency rates, and limb salvage for autologous vein LEB in CLI patients continue to be excellent in the endovascular era and are not necessarily affected by a prior ipsilateral endovascular procedure. Long-term survival remains poor in CLI patients requiring LEB.",
author = "Santo, {Vincent J.} and Phong Dargon and Amir Azarbal and Timothy Liem and Erica Mitchell and Gregory Landry and Moneta, {Gregory (Greg)}",
year = "2014",
doi = "10.1016/j.jvs.2014.01.013",
language = "English (US)",
volume = "60",
pages = "129--135",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Lower extremity autologous vein bypass for critical limb ischemia is not adversely affected by prior endovascular procedure

AU - Santo, Vincent J.

AU - Dargon, Phong

AU - Azarbal, Amir

AU - Liem, Timothy

AU - Mitchell, Erica

AU - Landry, Gregory

AU - Moneta, Gregory (Greg)

PY - 2014

Y1 - 2014

N2 - Objective It has been reported that a failed endovascular intervention adversely affects results of lower extremity bypass (LEB). We reviewed rates of prior endovascular intervention (PEI) in patients undergoing LEB with autologous vein for critical limb ischemia (CLI) to determine effects on graft patency, limb salvage, and amputation-free survival. Methods Retrospective review was conducted of consecutive autologous vein LEBs performed for CLI between 2005 and 2012 at a tertiary care academic medical center. Results Overall, 314 autologous vein LEBs were performed for CLI, 71% for tissue loss. TransAtlantic Inter-Society Consensus II type D or type C lesions were present in 62% and 25%, respectively. The great saphenous vein was used as a conduit in 83%, and the distal target was infrapopliteal in 60%. The 30-day mortality rate was 3.5%. Primary patency rates at 1 year and 5 years were 61% and 45%. Secondary patency rates at 1 year and 5 years were 88% and 64%, with 23% requiring an intervention to maintain patency. The 5-year limb salvage rate was 89%, and the 5-year amputation-free survival was 49%. There were 61 patients (19%) who had undergone a PEI and 253 (81%) who underwent bypass with no prior endovascular intervention (NPEI). There were 19 iliac stents, 29 femoral interventions, 13 popliteal interventions, 9 crural interventions, 9 infrainguinal thrombectomies, and 13 infrainguinal thrombolyses. PEI and NPEI patients had similar demographics and prevalence of atherosclerotic risk factors. The 1-year primary patency rate was 62% for NPEI patients vs 59% for PEI patients (P =.759). The 1-year and 2-year secondary patency rates were 87% and 79% for NPEI patients vs 89% and 78% for PEI patients (P =.947). The 3-year limb salvage rate was 89% for NPEI patients vs 92% for PEI patients (P =.445). The 3-year amputation-free survival was 59% for NPEI patients vs 52% for PEI patients (P =.399). Median follow-up time was 323 days for NPEI patients (interquartile range, 83-918) vs 463 days for PEI patients (interquartile range, 145-946; P =.275). Conclusions Overall operative mortality, patency rates, and limb salvage for autologous vein LEB in CLI patients continue to be excellent in the endovascular era and are not necessarily affected by a prior ipsilateral endovascular procedure. Long-term survival remains poor in CLI patients requiring LEB.

AB - Objective It has been reported that a failed endovascular intervention adversely affects results of lower extremity bypass (LEB). We reviewed rates of prior endovascular intervention (PEI) in patients undergoing LEB with autologous vein for critical limb ischemia (CLI) to determine effects on graft patency, limb salvage, and amputation-free survival. Methods Retrospective review was conducted of consecutive autologous vein LEBs performed for CLI between 2005 and 2012 at a tertiary care academic medical center. Results Overall, 314 autologous vein LEBs were performed for CLI, 71% for tissue loss. TransAtlantic Inter-Society Consensus II type D or type C lesions were present in 62% and 25%, respectively. The great saphenous vein was used as a conduit in 83%, and the distal target was infrapopliteal in 60%. The 30-day mortality rate was 3.5%. Primary patency rates at 1 year and 5 years were 61% and 45%. Secondary patency rates at 1 year and 5 years were 88% and 64%, with 23% requiring an intervention to maintain patency. The 5-year limb salvage rate was 89%, and the 5-year amputation-free survival was 49%. There were 61 patients (19%) who had undergone a PEI and 253 (81%) who underwent bypass with no prior endovascular intervention (NPEI). There were 19 iliac stents, 29 femoral interventions, 13 popliteal interventions, 9 crural interventions, 9 infrainguinal thrombectomies, and 13 infrainguinal thrombolyses. PEI and NPEI patients had similar demographics and prevalence of atherosclerotic risk factors. The 1-year primary patency rate was 62% for NPEI patients vs 59% for PEI patients (P =.759). The 1-year and 2-year secondary patency rates were 87% and 79% for NPEI patients vs 89% and 78% for PEI patients (P =.947). The 3-year limb salvage rate was 89% for NPEI patients vs 92% for PEI patients (P =.445). The 3-year amputation-free survival was 59% for NPEI patients vs 52% for PEI patients (P =.399). Median follow-up time was 323 days for NPEI patients (interquartile range, 83-918) vs 463 days for PEI patients (interquartile range, 145-946; P =.275). Conclusions Overall operative mortality, patency rates, and limb salvage for autologous vein LEB in CLI patients continue to be excellent in the endovascular era and are not necessarily affected by a prior ipsilateral endovascular procedure. Long-term survival remains poor in CLI patients requiring LEB.

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DO - 10.1016/j.jvs.2014.01.013

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JO - Journal of Vascular Surgery

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