Predictors of amputation-free survival and wound healing after infrainguinal bypass with alternative conduits.

Autor:	Matthay ZA; Department of Surgery, University of California, San Francisco, San Francisco, CA., Pace WA; Department of Surgery, University of California, San Francisco, San Francisco, CA. Electronic address: william.pace@ucsf.edu., Smith EJ; Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA., Gutierrez RD; Department of Surgery, University of California, San Francisco, San Francisco, CA., Gasper WJ; Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA., Hiramoto JS; Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA., Reilly LM; Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA., Conte MS; Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA., Iannuzzi JC; Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA.
Jazyk:	angličtina
Zdroj:	Journal of vascular surgery [J Vasc Surg] 2024 Jun; Vol. 79 (6), pp. 1447-1456.e2. Date of Electronic Publication: 2024 Feb 02.
DOI:	10.1016/j.jvs.2024.01.209
Abstrakt:	Objective: Inadequate vein quality or prior harvest precludes use of autologous single segment greater saphenous vein (ssGSV) in many patients with chronic limb-threatening ischemia (CLTI). Predictors of patient outcome after infrainguinal bypass with alternative (non-ssGSV) conduits are not well-understood. We explored whether limb presentation, bypass target, and conduit type were associated with amputation-free survival (AFS) after infrainguinal bypass using alternative conduits. Methods: A single-center retrospective study (2013-2020) was conducted of 139 infrainguinal bypasses performed for CLTI with cryopreserved ssGSV (cryovein) (n = 71), polytetrafluoroethylene (PTFE) (n = 23), or arm/spliced vein grafts (n = 45). Characteristics, Wound, Ischemia, and foot Infection (WIfI) stage, and outcomes were recorded. Multivariable Cox proportional hazards and classification and regression tree analysis modeled predictors of AFS. Results: Within 139 cases, the mean age was 71 years, 59% of patients were male, and 51% of cases were nonelective. More patients undergoing bypass with cryovein were WIfI stage 4 (41%) compared with PTFE (13%) or arm/spliced vein (27%) (P = .04). Across groups, AFS at 2 years was 78% for spliced/arm, 79% for PTFE, and 53% for cryovein (adjusted hazard ratio for cryovein, 2.5; P = .02). Among cases using cryovein, classification and regression tree analysis showed that WIfI stage 3 or 4, age >70 years, and prior failed bypass were predictive of the lowest AFS at 2 years of 36% vs AFS of 58% to 76% among subgroups with less than two of these factors. Although secondary patency at 2 years was worse in the cryovein group (26% vs 68% and 89% in arm/spliced and PTFE groups; P < .01), in patients with tissue loss there was no statistically significant difference in wound healing in the cryovein group (72%) compared with other bypass types (72% vs 87%, respectively; P = .12). Conclusions: In patients with CLTI lacking suitable ssGSV, bypass with autogenous arm/spliced vein or PTFE has superior AFS compared with cryovein, although data were limited for PTFE conduits for distal targets. Despite poor patency with cryovein, wound healing is achieved in a majority of cases, although it should be used with caution in older patients with high WIfI stage and prior failed bypass, given the low rates of AFS. Competing Interests: Disclosures M.C. is an advisory board member for Abbott Vascular. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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