Abstract
BackgroundDue to an increasing life expectancy, more and more patients experience the failure of peripheral arterial revascularization. This study aims to investigate patients treated for the failure of infra-inguinal bypass grafts, and to investigate the interaction of different bypass materials [great saphenous vein (GSV) and polytetrafluoroethylene (PTFE)] and the further outcome.MethodsRetrospective single-center analysis of consecutive patients treated for acute or chronic occlusion of infra-inguinal bypasses at a university hospital was conducted. Hospitalizations from 1st January 2010 through 31st December 2019 were included. Perioperative parameters from the index operation including graft material (prosthetic vs. autologous) were assessed. After bypass occlusion, the grade of ischemia, as well as the distal landing zone of the redo bypass compared with the primary bypass was investigated.ResultsIn this study, 158 (65% men and 35% women with a m mean age of 70.5 years) eligible patients were included (57% vein and 42% prosthetic bypass grafts). After graft occlusion, 47% of the patients presented with symptoms of acute limb-threatening ischemia, 53% with symptoms of chronic leg ischemia. The rate of acute limb-threatening ischemia was significantly higher when prosthetic graft material was used during the index operation (p =0.016). Additionally, in case of reoperation, the landing zone of the redo bypass was significantly more distally located after occlusion of prosthetic bypass graft (p = 0.014)ConclusionOcclusions of prosthetic bypass grafts were associated with significantly higher rates of acute symptoms compared with vein grafts. Additionally, a shift to a more distal landing zone was recognized after the failure of a prosthetic bypass graft during the redo bypass operation.
Highlights
More than 200 million people worldwide are known to be affected by peripheral artery disease (PAD) [1]
In cases where bypass operations are necessary for revascularization, the great saphenous vein (GSV) is recommended as graft material; prosthetic bypass grafts (such as polytetrafluoroethylene (PTFE)/expanded PTFE grafts) should only be considered if there is no vein material available, and the revascularization cannot be done by an endovascular approach [3]
All patients treated for chronic (Fontaine stages II-IV) or acute (Rutherford stages I-III) due to the first occlusion of an infrainguinal bypass graft were included in this study
Summary
More than 200 million people worldwide are known to be affected by peripheral artery disease (PAD) [1]. This is the result of increasing numbers of patients with diabetes mellitus on the one hand, on the other hand due to demographic changes. The number of patients treated either by endovascular procedures or open surgical procedures is increasing [2]. Due to an increasing life expectancy, more and more patients experience the failure of peripheral arterial revascularization. This study aims to investigate patients treated for the failure of infra-inguinal bypass grafts, and to investigate the interaction of different bypass materials [great saphenous vein (GSV) and polytetrafluoroethylene (PTFE)] and the further outcome
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