Abstract
Introduction: Infra-inguinal bypass is the most common surgical procedure performed for critical lower extremity ischaemia. Outcomes in-terms of; survival, graft patency and freedom from major amputation vary significantly in the literature and are influenced by many factors including patient co-morbidity, anatomical site of bypass and choice of bypass conduit. Here is presented contemporary outcomes of all infra-inguinal bypass grafts performed at a single vascular hub between January 2015 and January 2019. Methods: This is a single centre, retrospective cohort study. Demographic, disease and procedural data was extracted from eligible cases identified within a national vascular registry (VSQIP-NVR). This was then cross-referenced with hospital episode statistic (HES) codes to ensure adequate data capture. In-house electronic records (clinical results reporting system, CRRS) were interrogated for follow up, re-intervention and survival outcome measures. Statistical analysis was performed using SPSS 25 (IBM). Survival estimates were calculated using the Kaplan-Meier method. Results: 185 Eligible infra inguinal bypass procedures were Identified. This consisted of 79 elective and 106 non-elective admissions. Mean age at surgery was 69 (±13) years. Tissue loss was present in 46%(n=85) of patients. Autologous vein was the conduit of choice in 90% (n=165) with reversed vein and in-situ vein accounting for 76% (n=143) and 14% (n=26) respectively. 87% of patients were enrolled into ultrasound surveillance. Mean duration of follow up was 42 (0-51) months. At 6 months, 1 and 3 years primary patency was 68%, 60% and 54% respectively.Mean time to first intervention was 14 months (IQR 3-22 months). 88% of all interventions to maintain patency were carried out by 24 months.At 6 months, 1 and 3 years secondary patency was 93%, 88% & 86% respectively. At 6 months, 1 and 3 years limb salvagewas 85%, 81% & 79% respectively. Estimated survival and limb salvage rates were significantly lower in non-elective procedures in comparison to elective procedures (p=0.07 & p=0.03 respectively). There was no difference in primary or secondary patency between popliteal and distal bypasses, however, limb salvage was significantly better in popliteal bypasses (p=0.03). Conclusion: Infra-inguinal bypass remains the gold standard in lower limb revascularisation. This case series highlights excellent patency and limb salvage into the medium term. We would advocate ultrasound surveillance as a significant proportion (38%) of grafts require maintenance to ensure continued patency, our data would support a surveillance period of 24-months as sufficient, 88% of all graft interventions to maintain patency were performed by 24 months. It may be possible limit graft surveillance, provided patients have been intervention free. As anticipated, patients who undergo non elective bypass are at greater risk of major amputation than their elective counterparts. Disclosure: Nothing to disclose
Published Version
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