Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2010 Jun;51(6):1419-24.
doi: 10.1016/j.jvs.2010.01.083. Epub 2010 Apr 24.

Failure to achieve clinical improvement despite graft patency in patients undergoing infrainguinal lower extremity bypass for critical limb ischemia

Jessica P Simons  1 , Philip P Goodney, Brian W Nolan, Jack L Cronenwett, Louis M Messina, Andres Schanzer; Vascular Study Group of Northern New England
Affiliations
Multicenter Study

Failure to achieve clinical improvement despite graft patency in patients undergoing infrainguinal lower extremity bypass for critical limb ischemia

Jessica P Simons et al. J Vasc Surg. 2010 Jun.

Abstract

Objective: Studies of infrainguinal lower extremity bypass for critical limb ischemia (CLI) have traditionally emphasized outcomes of patency, limb salvage, and death. Because functional outcomes are equally important, our objectives were to describe the proportion of CLI patients who did not achieve symptomatic improvement 1 year after bypass, despite having patent grafts, and identify preoperative factors associated with this outcome.

Methods: The prospectively collected Vascular Study Group of Northern New England database was used to identify all patients with elective infrainguinal lower extremity bypass for CLI (2003 to 2007) for whom long-term follow-up data were available. The primary composite study end point was clinical failure at 1 year after bypass, defined as amputation or persistent or worsened ischemic symptoms (rest pain or tissue loss), despite a patent graft. Variables identified on univariate screening (inclusion threshold, P < .20) were included in a multivariable logistic regression model to identify independent predictors.

Results: Long-term follow-up data were available for 1012 patients who underwent infrainguinal bypasses for CLI, of which 788 (78%) remained patent at 1 year. Of these, 79 (10%) met criteria for the composite end point of clinical failure: 21 (2.7%) for major amputations and 58 (7.4%) for persistent rest pain or tissue loss. In multivariable analysis, significant predictors of clinical failure included dialysis dependence (odds ratio [OR], 3.74; 95% confidence interval [CI], 1.84-7.62; P < .001) and preoperative inability to ambulate independently (OR, 2.17; 95% CI, 1.26-3.73; P = .005). A history of coronary artery bypass graft or percutaneous coronary intervention was protective (OR, 0.52; 95% CI, 0.29-0.93; P = .03).

Conclusions: After infrainguinal lower extremity bypass for CLI, 10% of patients with a patent graft did not achieve clinical improvement at 1 year. Preoperative identification of this specific patient subgroup remains challenging. To improve surgical decision making and the overall care of CLI patients, further emphasis needs to be placed on functional outcomes in addition to traditional surgical end points.

PubMed Disclaimer

Conflict of interest statement

Competition of interest: none. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.

Figures

Fig 1
Fig 1
Flowchart shows cohort selection for primary analysis of clinical failure, defined as persistent rest pain, tissue loss, or ipsilateral major amputation at 1 year, despite a patent graft. CLI, Critical limb ischemia; iLEB, infrainguinal lower extremity bypass.
Fig 2
Fig 2
Transition of health states are shown at the 1-year follow-up according to indication for lower extremity bypass.
See this image and copyright information in PMC

References

    1. Schanzer A, Hevelone N, Owens CD, Belkin M, Bandyk DF, Clowes AW, et al. Technical factors affecting autogenous vein graft failure: observations from a large multicenter trial. J Vasc Surg. 2007;46:1180–90. discussion 90. - PubMed
    1. Robinson WP, 3rd, Owens CD, Nguyen LL, Chong TT, Conte MS, Belkin M. Inferior outcomes of autogenous infrainguinal bypass in Hispanics: an analysis of ethnicity, graft function, and limb salvage. J Vasc Surg. 2009;49:1416–25. - PubMed
    1. Rossi PJ, Skelly CL, Meyerson SL, Bassiouny HS, Katz D, Schwartz LB, et al. Redo infrainguinal bypass: factors predicting patency and limb salvage. Ann Vasc Surg. 2003;17:492–502. - PubMed
    1. Toursarkissian B, D’Ayala M, Stefanidis D, Shireman PK, Harrison A, Schoolfield J, et al. Angiographic scoring of vascular occlusive disease in the diabetic foot: relevance to bypass graft patency and limb salvage. J Vasc Surg. 2002;35:494–500. - PubMed
    1. Owens CD, Ho KJ, Kim S, Schanzer A, Lin J, Matros E, et al. Refinement of survival prediction in patients undergoing lower extremity bypass surgery: stratification by chronic kidney disease classification. J Vasc Surg. 2007;45:944–52. - PubMed

Publication types

MeSH terms