Early graft failure after infrainguinal arterial bypass

Abstract

Introduction: Early graft failure (EGF), defined as failure within 30 days of an index procedure, is a serious complication after infrainguinal arterial bypass. EGF has not been examined by the use of national data since the widespread adoption of percutaneous treatments for arterial occlusive disease.

Methods: We used data from the American College of Surgeons National Surgical Quality Improvement Program. Patients who underwent infrainguinal arterial bypass from 2005 to 2011 were selected from the American College of Surgeons National Surgical Quality Improvement Program database. The frequency of 30-day EGF was determined. Univariate and multivariate analyses evaluated risk factors for EGF.

Results: Of 23,468 patients who underwent open infrainguinal arterial bypass, 1,065 (4.5%) had EGF. Patients who had EGF were more likely to have a prolonged duration of stay (34.8% vs 12.0%, P < .001), greater rates of reoperation (82.1% vs 14.3%, P < .001) and increased 30-day mortality (5.1% vs 2.1%, P < .001). The rate of additional complications in patients who experienced EGF was 42.0%, compared with 25.4% in those who did not have EGF (P < .001). Patients who experienced complications in addition to EGF were more likely to have complications after graft failure (69.5% vs 31.3%). In multivariable analysis, EGF was associated with younger age, female sex, black race, obesity, thrombocytosis, increased international normalized ratio, femoral-to-tibial bypass, prosthetic graft, and emergent operation.

Conclusion: The incidence of EGF after open lower extremity arterial bypass has not increased in an era of increased use of percutaneous techniques. Nevertheless, EGF occurs in almost 5% of patients and is strongly associated with additional complications and mortality. Identifying patients at risk for EGF may facilitate modification of contributing factors. Diminishing the incidence of graft occlusion will lead to decreased morbidity and mortality in this cohort of patients.