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

Everett Y. Lam, Gregory J. Landry, James M. Edwards, Richard A. Yeager, Lloyd M. Taylor, Gregory L. 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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    19 Scopus citations

    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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    ASJC Scopus subject areas

    • Surgery
    • Cardiology and Cardiovascular Medicine

    Cite this

    Lam, E. Y., Landry, G. J., Edwards, J. M., Yeager, R. A., Taylor, L. M., Moneta, G. L., Sicard, G. A., Louridas, G., Gibbons, G. W., Kim, G. E., Blebea, J., Ascher, E., Hans, S. S., & Alvarez, J. (2004). Risk factors for autogenous infrainguinal bypass occlusion in patients with prosthetic inflow grafts. Journal of vascular surgery, 39(2), 336-342. https://doi.org/10.1016/j.jvs.2003.09.031