Effects of endovascular first strategy on spliced vein bypass outcomes

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ObjectiveAggressive endovascular interventions for patients without adequate full-length venous conduit have gained popularity. The purpose of this study is to evaluate the outcomes of spliced vein bypass (SVB) as primary treatment versus treatment after failed endovascular intervention (endovascular SVB [ESVB]) for infrainguinal revascularization. MethodsA retrospective analysis of a single vascular group's database of all SVBs was queried for demographics, indications, intraoperative details, and outcomes. Exclusion criteria included acute ischemia, aneurysm, dual outflow, bypass revisions, and patients lost to immediate follow-up. SPSS software was used for statistical analysis. ResultsTwo hundred thirty-five infrainguinal SVBs were performed between January 2011 and March 2017. There were 182 SVB (77%) and 53 ESVB (23%) with a mean follow-up of 488 days (range, 1-2140). Demographics between the SVB and ESVB groups were similar in all categories recorded: diabetes, hypertension, coronary artery disease, current smoker, chronic obstructive pulmonary disease, hyperlipidemia, and renal disease (P = .29). Indications for bypass were not statistically significant between SVB and ESVB (P = .48). The study included Rutherford class 3 (14 vs 2), class 4 (51 vs 20), class 5 (67 vs 18), and class 6 (50 vs 13). Inflow was grouped into iliac (2.6%), femoral (88%), and popliteal (9.8%). Outflow arteries were grouped into below knee popliteal (14.9%) and infrapopliteal (85.1%). Inflow and outflow arteries, as well as number of spliced pieces per bypass were not different between groups. Major amputation rates were not different between SVB and ESVB for the entire study period. There was no statistical difference with patency outcomes based on Kaplan-Meier survival analysis (P = .84). ConclusionsAn aggressive endovascular first strategy for treatment of patients without adequate autogenous conduit seems to offer benefit without negatively affecting future bypass options. SVB patency and major amputation rates in this series were not affected by a prior endovascular treatment.