Analysis of risk factors for occlusions of a synthetic femoropopliteal bypass graft
Abstract
Background/Aim. Femoropopliteal bypass is a revascularization technique of lower extremities with excellent outcome. The great saphenous vein is the best graft material, but if it is not adequate or has been removed, synthetic grafts are an useful alternative. Graft occlusion is the most significant complication with the most serious consequences. The aim of this study was to analyse predictive factors for the synthetic femoropopliteal bypass occlusions. Methods. This retrospective case-control study included all patients who underwent synthetic femoropopliteal bypass due to peripheral arterial occlusive disease at the Vascular Surgery Center, Clinical Center of Kragujevac, Serbia, from 2007 to 2013. The cases group were the patients with femoropopliteal graft occlusion (n = 44), with the control group consisted of the patients without such an outcome (n = 88). Results. Significant effects to occlusion were: concomitant cardiovascular disease (adjustedOR 27.05; 95% CI 4.74; 154.35), a type of femoropopliteal bypass (adjustedOR 16.50; 95% CI 4.05; 67.24), previous vascular intervention (adjustedOR 4.67; 95% CI 1.20; 18.14), clinical stage of the disease (adjustedOR 3.73; 95% CI 1.94; 7.18), administration of postoperative oral anticoagulant therapy (adjustedOR 0.05; 95% CI 0.01; 0.23) and the use of angiotensin converting enzyme inhibitors (adjustedOR 0.14; 95% CI 0.03; 0.70). A significant synergism was shown for the following combinations of the observed risk factors: type of femoropopliteal bypass and cardiovascular disease, type of femoropopliteal bypass and previous vascular intervention, previous vascular intervention and cardiovascular disease, previous vascular intervention and beta blockers, cardiovascular disease and diabetes, type of femoropopliteal bypass and antiaggregant therapy, clinical stage of disease and cardiovascular disease, previous vascular intervention and antiaggregant therapy. Conclusion. Concomitant cardiovascular disease, below-knee femoropopliteal bypass, advanced stage of vascular disease and non-use of anticoagulant therapy and angiotensin-converting enzyme inhibitors are the significant predictors of graft occlusion after synthetic femoropopliteal bypass. Their synergistic effect determines the importance of diabetes, use of beta blockers and platelet antiaggregant therapy.
References
Takagi H, Goto S, Matsui M, Manabe H, Umemoto T. A contem-porary meta-analysis of Dacron versus polytetrafluoroethylene grafts for femoropopliteal bypass grafting. J Vasc Surg 2010; 52(1): 232−6.
Debus ES, Larena-Avellaneda A, Heimlich F, Goertz J, Fein M. Al-loplastic bypass material below the knee: actual rationale. J Cardiovasc Surg (Torino) 2013; 54(Suppl 1): 159−66.
Dohmen A, Eder S, Euringer W, Zeller T, Beyersdorf F. Chronic critical limb ischemia. Dtsch Arztebl Int 2012; 109(6): 95−101.
Baldwin ZK, Pearce BJ, Curi MA, Desai TR, McKinsey JF, Bassiouny HS, et al. Limb salvage after infrainguinal bypass graft failure. J Vasc Surg 2004; 39(5): 951−7.
Goodney PP, Nolan BW, Schanzer A, Eldrup-Jorgensen J, Bertges DJ, Stanley AC, et al. Factors associated with amputation or graft occlusion one year after lower extremity bypass in northern New England. Ann Vasc Surg 2010; 24(1): 57−68.
Pulli R, Dorigo W, Castelli P, Dorrucci V, Ferilli F, De BG, et al. Midterm results from a multicenter registry on the treatment of infrainguinal critical limb ischemia using a heparin-bonded ePTFE graft. J Vasc Surg 2010; 51(5): 1167−77.
Hertzer NR, Bena JF, Karafa MT. A personal experience with the influence of diabetes and other factors on the outcome of infrainguinal bypass grafts for occlusive disease. J Vasc Surg 2007; 46(2): 271−9.
Singh N, Sidawy AN, de Zee KJ, Neville RF, Akbari C, Henderson W. Factors associated with early failure of infrainguinal lower extremity arterial bypass. J Vasc Surg 2008; 47(3): 556−61.
Tangelder MJ, Algra A, Lawson JA, Eikelboom BC. Risk factors for occlusion of infrainguinal bypass grafts. Eur J Vasc Endovasc Surg 2000; 20(2): 118−24.
Alpagut U, Ugurlucan M, Banach M, Mikhailidis DP, Dayioglu E. Does gender influence the patency of infrainguinal bypass grafts. Angiology 2008; 59(3): 278−82.
Brumberg RS, Back MR, Armstrong PA, Cuthbertson D, Shames ML, Johnson BL, et al. The relative importance of graft surveillance and warfarin therapy in infrainguinal prosthetic bypass failure. J Vasc Surg 2007; 46(6): 1160−6.
Lancaster RT, Conrad MF, Patel VI, Cambria RP, LaMuraglia GM. Predictors of early graft failure after infrainguinal bypass surgery: a risk-adjusted analysis from the NSQIP. Eur J Vasc Endovasc Surg 2012; 43(5): 549−55.
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(6): 1180−90.
Bosiers M, Deloose K, Verbist J, Schroë H, Lauwers G, Lansink W, et al. Heparin-bonded expanded polytetrafluoroethylene vascular graft for femoropopliteal and femorocrural bypass grafting: 1-year results. J Vasc Surg 2006; 43(2): 313−8.
Nolan BW, de Martino RR, Stone DH, Schanzer A, Goodney PP, Walsh DW, et al. Prior failed ipsilateral percutaneous endovas-cular intervention in patients with critical limb ischemia pre-dicts poor outcome after lower extremity bypass. J Vasc Surg 2011; 54(3): 730−5.
Baril DT, Goodney PP, Robinson WP, Nolan BW, Stone DH, Li Y, et al. Prior contralateral amputation predicts worse outcomes for lower extremity bypasses performed in the intact limb. J Vasc Surg 2012; 56(2): 353−60.
Brown J, Lethaby A, Maxwell H, Wawrzyniak AJ, Prins MH. An-tiplatelet agents for preventing thrombosis after peripheral ar-terial bypass surgery. Cochrane Database Syst Rev 2008; 8(4): CD000535.
Henke PK, Blackburn S, Proctor MC, Stevens J, Mukherjee D, Ra-jagopalin S, et al. Patients undergoing infrainguinal bypass to treat atherosclerotic vascular disease are underprescribed car-dioprotective medications: effect on graft patency, limb sal-vage, and mortality. J Vasc Surg 2004; 39(2): 357−65.
Twine CP, Mclain AD. Graft type for femoro-popliteal bypass surgery. Cochrane Database Syst Rev 2010; 12(5): CD001487.
Jensen LP, Lepäntalo M, Fossdal JE, Røder OC, Jensen BS, Madsen MS, et al. Dacron or PTFE for above-knee FP bypass. a multi-center randomised study. Eur J Vasc Endovasc Surg 2007; 34(1): 44−9.
Van Det RJ, Vriens BH, van der Palen J, Geelkerken RH. Dacron or ePTFE for femoro-popliteal above-knee bypass grafting: short- and long-term results of a multicentre randomised trial. Eur J Vasc Endovasc Surg 2009; 37(4): 457−63.
Engelhardt M, Boos J, Bruijnen H, Wohlgemuth W, Willy C, Tann-heimer M, et al. Critical limb ischaemia: initial treatment and predictors of amputation-free survival. Eur J Vasc Endovasc Surg 2012; 43(1): 55−61.
Antoniou GA, Chalmers N, Georgiadis GS, Lazarides MK, Antoniou SA, Serracino-Inglott F, et al. A meta-analysis of endovascular versus surgical reconstruction of femoropopliteal arterial dis-ease. J Vasc Surg 2013; 57(1): 242−53.
Taylor SM, York JW, Cull DL, Kalbaugh CA, Cass AL, Langan EM. Clinical success using patient-oriented outcome measures after lower extremity bypass and endovascular intervention for ischemic tissue loss. J Vasc Surg 2009; 50(3): 534−41.
Söderström M, Arvela E, Aho PS, Lepäntalo M, Albäck A. High leg salvage rate after infrainguinal bypass surgery for ischemic tissue loss (Fontaine IV) is compromised by the short life ex-pectancy. Scand J Surg 2010; 99(4): 230−4.
Smeets L, Ho GH, Tangelder MJ, Algra A, Lawson JA, Eikelboom BC, et al. Outcome after occlusion of infrainguinal bypasses in the Dutch BOA Study: comparison of amputation rate in ve-nous and prosthetic grafts. Eur J Vasc Endovasc Surg 2005; 30(6): 604−9.
Jackson MR, Johnson WC, Williford WO, Valentine JR, Clagett PG. The effect of anticoagulation therapy and graft selection on the ischemic consequences of femoropopliteal bypass graft occlusion: results from a multicenter randomized clinical trial. J Vasc Surg 2002; 35(2): 292−8.
Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, re-nal, mesenteric, and abdominal aortic): executive summary a collaborative report. J Am Coll Cardiol 2006; 21(47): 1239−312.
Mohler E 3rd, Giri J; ACC; AHA. Management of peripheral arterial disease patients: comparing the ACC/AHA and TASC-II guidelines. Curr Med Res Opin 2008; 24(9): 2509−22.
Moxey PW, Hofman D, Hinchliffe RJ, Jones K, Thompson MM, Holt PJ. Trends and outcomes after surgical lower limb revasculari-zation in England. Br J Surg 2011; 98(10): 1373−82.
Inan B, Aydin U, Ugurlucan M, Aydin C, Teker ME. Surgical treatment of lower limb ischemia in diabetic patients - long-term results. Arch Med Sci 2013; 9(6): 1078−82.
Pulli R, Dorigo W, Guidotti A, Fargion A, Alessi IA, Pratesi C. The Role of Infrainguinal Bypass Surgery in the Endovascular Era. Ann Vasc Dis 2014; 7(1): 7−10.