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Objective: Utilization of a distal vein patch or cuff in conjunction with femorodistal bypasses (FDB) using prosthetic has been suggested to increase patency and limb salvage. This analysis evaluated the use of a distal vein cuff or patch and its impact on limb salvage after femorotibial bypass with prosthetic conduit.
Methods: Medicare patients undergoing prosthetic FDB with and without the use of a vein cuff or patch were identified from Medicare (MedPAR) and Carrier files using ICD-9-CM and CPT-4 codes. Covariates included demographics, co-morbidities and disease severity. Complications and freedom from major amputation (above and below knee) were evaluated with Chi-square and Kaplan-Meier tests and Cox regression.
Results: We identified 8,106 patients undergoing prosthetic FDB: 7,054 without the use of a vein cuff and 1,052 (13.0%) with the use of a vein cuff. Mean age of the population was 75 years, 60% of the population was male, and 78% of the population was white. No significant differences in major amputation (MA) rates were noted in chi square analysis at 30 days (8.3% and 7.1%; P=0.19) or one year (25.0% and 22.4%; P=0.11). Kaplan-Meier analysis for MA within one year (Fig.1) and Cox regression with adjustment for age, race, gender, comorbidities, and disease severity failed to show a significant difference between no cuff vs. cuff (HR=1.13; 95%CI 0.98-1.31). No difference in hospital complications or secondary procedures was found.
Conclusions: Patients undergoing femorodistal bypass using a prosthetic graft with use of a distal vein cuff did not demonstrate a benefit or improved freedom from amputation in the Medicare population. This suggests that vein cuff may be an unnecessary adjunct for these procedures.