Risk factors for autogenous infrainguinal bypass occlusion in patients with prosthetic inflow grafts

Everett Y. Lam, Gregory Landry, James Edwards, Richard A. Yeager, Lloyd M. Taylor, Gregory (Greg) Moneta, Gregorio A. Sicard, George Louridas, Gary W. Gibbons, Geun Eun Kim, John Blebea, Enrico Ascher, Sachinder S. Hans, Jose Alvarez

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    Abstract

    Objective: In patients with prosthetic inflow (PI) grafts the proximal anastomosis of autogenous infrainguinal bypass (AIB) can be placed on the PI or on a distal native vessel in the groin. This study was performed to determine the effect of placement of an AIB proximal anastomotic site in a patient with ipsilateral PI. Methods: Patients undergoing AIB and PI between January 1990 and July 2002 were included in the study. They were classified into two groups on the basis of location of the proximal anastomosis. In group 1 the AIB proximal anastomosis was placed on the PI in the groin, whereas in group 2 the AIB proximal anastomosis was placed on a distal native groin artery. Patency, limb salvage, and patient survival in the two groups were calculated with the Kaplan-Meier method. The Cox proportional hazards model was used to determine independent risk factors affecting AIB patency. Results: Two hundred twenty-nine patients underwent AIB and PI. In group 1, 23 AIBs became thrombosed concurrent with 26 PI occlusions, and in group 2, 7 AIBs became thrombosed concurrent with 36 PI occlusions (P <.001). Five-year assisted primary patency, limb salvage, and patient survival in groups 1 and 2 were 50% and 75% (P <.001, log-rank test), 78% and 90% (P = .005, log-rank test), and 56% and 69% (P = NS, log-rank test), respectively. Factors independently associated with AIB occlusion are hypertension (hazard ratio [HR], 3.41; 95% confidence interval [CI], 1.65-7.05; P = .001), postoperative warfarin sodium therapy (HR, 1.86; 95% CI, 1.07-3.23; P = .03), continued smoking (HR, 1.72; 95% CI, 0.93-3.18; P=.08), AIB arising from PI (HP, 2.38; 95% CI, 1.35-4.18; P=.003), and PI occlusion (HR, 3.70; 95% CI, 2.15-6.36; P <.001). Conclusion: A proximal AIB anastomosis located directly on the PI is an independent risk factor for decreased AIB patency of equal or greater importance than current smoking, hypertension, or PI occlusion. The proximal anastomosis of an AIB in a patient with an ipsilateral PI should be placed on a distal native artery.

    Original languageEnglish (US)
    Pages (from-to)336-342
    Number of pages7
    JournalJournal of Vascular Surgery
    Volume39
    Issue number2
    DOIs
    StatePublished - Feb 2004

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    Transplants
    Confidence Intervals
    Groin
    Limb Salvage
    Thrombosis
    Arteries
    Smoking
    Hypertension
    Survival
    Warfarin
    Proportional Hazards Models
    Therapeutics

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery

    Cite this

    Risk factors for autogenous infrainguinal bypass occlusion in patients with prosthetic inflow grafts. / Lam, Everett Y.; Landry, Gregory; Edwards, James; Yeager, Richard A.; Taylor, Lloyd M.; Moneta, Gregory (Greg); Sicard, Gregorio A.; Louridas, George; Gibbons, Gary W.; Kim, Geun Eun; Blebea, John; Ascher, Enrico; Hans, Sachinder S.; Alvarez, Jose.

    In: Journal of Vascular Surgery, Vol. 39, No. 2, 02.2004, p. 336-342.

    Research output: Contribution to journalArticle

    Lam, EY, Landry, G, Edwards, J, Yeager, RA, Taylor, LM, Moneta, GG, Sicard, GA, Louridas, G, Gibbons, GW, Kim, GE, Blebea, J, Ascher, E, Hans, SS & Alvarez, J 2004, 'Risk factors for autogenous infrainguinal bypass occlusion in patients with prosthetic inflow grafts', Journal of Vascular Surgery, vol. 39, no. 2, pp. 336-342. https://doi.org/10.1016/j.jvs.2003.09.031
    Lam, Everett Y. ; Landry, Gregory ; Edwards, James ; Yeager, Richard A. ; Taylor, Lloyd M. ; Moneta, Gregory (Greg) ; Sicard, Gregorio A. ; Louridas, George ; Gibbons, Gary W. ; Kim, Geun Eun ; Blebea, John ; Ascher, Enrico ; Hans, Sachinder S. ; Alvarez, Jose. / Risk factors for autogenous infrainguinal bypass occlusion in patients with prosthetic inflow grafts. In: Journal of Vascular Surgery. 2004 ; Vol. 39, No. 2. pp. 336-342.
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    abstract = "Objective: In patients with prosthetic inflow (PI) grafts the proximal anastomosis of autogenous infrainguinal bypass (AIB) can be placed on the PI or on a distal native vessel in the groin. This study was performed to determine the effect of placement of an AIB proximal anastomotic site in a patient with ipsilateral PI. Methods: Patients undergoing AIB and PI between January 1990 and July 2002 were included in the study. They were classified into two groups on the basis of location of the proximal anastomosis. In group 1 the AIB proximal anastomosis was placed on the PI in the groin, whereas in group 2 the AIB proximal anastomosis was placed on a distal native groin artery. Patency, limb salvage, and patient survival in the two groups were calculated with the Kaplan-Meier method. The Cox proportional hazards model was used to determine independent risk factors affecting AIB patency. Results: Two hundred twenty-nine patients underwent AIB and PI. In group 1, 23 AIBs became thrombosed concurrent with 26 PI occlusions, and in group 2, 7 AIBs became thrombosed concurrent with 36 PI occlusions (P <.001). Five-year assisted primary patency, limb salvage, and patient survival in groups 1 and 2 were 50{\%} and 75{\%} (P <.001, log-rank test), 78{\%} and 90{\%} (P = .005, log-rank test), and 56{\%} and 69{\%} (P = NS, log-rank test), respectively. Factors independently associated with AIB occlusion are hypertension (hazard ratio [HR], 3.41; 95{\%} confidence interval [CI], 1.65-7.05; P = .001), postoperative warfarin sodium therapy (HR, 1.86; 95{\%} CI, 1.07-3.23; P = .03), continued smoking (HR, 1.72; 95{\%} CI, 0.93-3.18; P=.08), AIB arising from PI (HP, 2.38; 95{\%} CI, 1.35-4.18; P=.003), and PI occlusion (HR, 3.70; 95{\%} CI, 2.15-6.36; P <.001). Conclusion: A proximal AIB anastomosis located directly on the PI is an independent risk factor for decreased AIB patency of equal or greater importance than current smoking, hypertension, or PI occlusion. The proximal anastomosis of an AIB in a patient with an ipsilateral PI should be placed on a distal native artery.",
    author = "Lam, {Everett Y.} and Gregory Landry and James Edwards and Yeager, {Richard A.} and Taylor, {Lloyd M.} and Moneta, {Gregory (Greg)} and Sicard, {Gregorio A.} and George Louridas and Gibbons, {Gary W.} and Kim, {Geun Eun} and John Blebea and Enrico Ascher and Hans, {Sachinder S.} and Jose Alvarez",
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    T1 - Risk factors for autogenous infrainguinal bypass occlusion in patients with prosthetic inflow grafts

    AU - Lam, Everett Y.

    AU - Landry, Gregory

    AU - Edwards, James

    AU - Yeager, Richard A.

    AU - Taylor, Lloyd M.

    AU - Moneta, Gregory (Greg)

    AU - Sicard, Gregorio A.

    AU - Louridas, George

    AU - Gibbons, Gary W.

    AU - Kim, Geun Eun

    AU - Blebea, John

    AU - Ascher, Enrico

    AU - Hans, Sachinder S.

    AU - Alvarez, Jose

    PY - 2004/2

    Y1 - 2004/2

    N2 - Objective: In patients with prosthetic inflow (PI) grafts the proximal anastomosis of autogenous infrainguinal bypass (AIB) can be placed on the PI or on a distal native vessel in the groin. This study was performed to determine the effect of placement of an AIB proximal anastomotic site in a patient with ipsilateral PI. Methods: Patients undergoing AIB and PI between January 1990 and July 2002 were included in the study. They were classified into two groups on the basis of location of the proximal anastomosis. In group 1 the AIB proximal anastomosis was placed on the PI in the groin, whereas in group 2 the AIB proximal anastomosis was placed on a distal native groin artery. Patency, limb salvage, and patient survival in the two groups were calculated with the Kaplan-Meier method. The Cox proportional hazards model was used to determine independent risk factors affecting AIB patency. Results: Two hundred twenty-nine patients underwent AIB and PI. In group 1, 23 AIBs became thrombosed concurrent with 26 PI occlusions, and in group 2, 7 AIBs became thrombosed concurrent with 36 PI occlusions (P <.001). Five-year assisted primary patency, limb salvage, and patient survival in groups 1 and 2 were 50% and 75% (P <.001, log-rank test), 78% and 90% (P = .005, log-rank test), and 56% and 69% (P = NS, log-rank test), respectively. Factors independently associated with AIB occlusion are hypertension (hazard ratio [HR], 3.41; 95% confidence interval [CI], 1.65-7.05; P = .001), postoperative warfarin sodium therapy (HR, 1.86; 95% CI, 1.07-3.23; P = .03), continued smoking (HR, 1.72; 95% CI, 0.93-3.18; P=.08), AIB arising from PI (HP, 2.38; 95% CI, 1.35-4.18; P=.003), and PI occlusion (HR, 3.70; 95% CI, 2.15-6.36; P <.001). Conclusion: A proximal AIB anastomosis located directly on the PI is an independent risk factor for decreased AIB patency of equal or greater importance than current smoking, hypertension, or PI occlusion. The proximal anastomosis of an AIB in a patient with an ipsilateral PI should be placed on a distal native artery.

    AB - Objective: In patients with prosthetic inflow (PI) grafts the proximal anastomosis of autogenous infrainguinal bypass (AIB) can be placed on the PI or on a distal native vessel in the groin. This study was performed to determine the effect of placement of an AIB proximal anastomotic site in a patient with ipsilateral PI. Methods: Patients undergoing AIB and PI between January 1990 and July 2002 were included in the study. They were classified into two groups on the basis of location of the proximal anastomosis. In group 1 the AIB proximal anastomosis was placed on the PI in the groin, whereas in group 2 the AIB proximal anastomosis was placed on a distal native groin artery. Patency, limb salvage, and patient survival in the two groups were calculated with the Kaplan-Meier method. The Cox proportional hazards model was used to determine independent risk factors affecting AIB patency. Results: Two hundred twenty-nine patients underwent AIB and PI. In group 1, 23 AIBs became thrombosed concurrent with 26 PI occlusions, and in group 2, 7 AIBs became thrombosed concurrent with 36 PI occlusions (P <.001). Five-year assisted primary patency, limb salvage, and patient survival in groups 1 and 2 were 50% and 75% (P <.001, log-rank test), 78% and 90% (P = .005, log-rank test), and 56% and 69% (P = NS, log-rank test), respectively. Factors independently associated with AIB occlusion are hypertension (hazard ratio [HR], 3.41; 95% confidence interval [CI], 1.65-7.05; P = .001), postoperative warfarin sodium therapy (HR, 1.86; 95% CI, 1.07-3.23; P = .03), continued smoking (HR, 1.72; 95% CI, 0.93-3.18; P=.08), AIB arising from PI (HP, 2.38; 95% CI, 1.35-4.18; P=.003), and PI occlusion (HR, 3.70; 95% CI, 2.15-6.36; P <.001). Conclusion: A proximal AIB anastomosis located directly on the PI is an independent risk factor for decreased AIB patency of equal or greater importance than current smoking, hypertension, or PI occlusion. The proximal anastomosis of an AIB in a patient with an ipsilateral PI should be placed on a distal native artery.

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