Age Related Splice Vein Bypass Outcomes
Tigran Divanyan, MD, Nicholas Russo, M.D., Misak Harutyunyan, B.S., Neil Patel, B.S., Ralph Clement Darling, III, M.D., Jeffrey Hnath, M.D..
Albany Medical Center, Albany, NY, USA.
Objectives:Critical limb ischemia requiring open revascularization in conduit limited patients presents unique management challenges. Differences in long term survival and amputation based on age in patients undergoing splice vein bypass has not been well studied. The purpose of this study was to evaluate and compare outcomes of splice vein bypasses in various age groups. Methods:A single vascular group’s database was queried for all patients who received a splice vein bypass from 2016-2021. These patients were divided into three groups based on age: <80, 80-89, >90. Demographics and long-term results were recorded and compared. Groups were compared utilizing standard statistics.Results: Between 2016 and 2021, there were 244 splice vein reconstructions (209 (<80), 30 (80-89), 5 (90+)). Rates of diabetes, hypertension, coronary artery disease, tobacco use, hyperlipidemia, and renal failure were similar between patients under and over 80 years old (p>0.05). Mean follow up was 747 days (0-1903 days) (p>0.05). The most common indications for intervention were gangrene, rest pain, and non-healing ulcer, with patients over 80 years old being more likely to undergo intervention for gangrene (p=0.019). Patients over 80 were more likely to have SFA as their inflow (p<0.01), and DP as their outflow (p=0.002). 30-day complication rates were similar between the <80, 80-89, and 90+ cohorts (23% (48), 17% (5), 20% (1)) (p>0.05). 5-year total survival was not statistically different between the three cohorts (46.9%, 40.81, 40%) (p=.356). 5-year amputation free survival was not statistically different between the three cohorts (79.7%, 89.6, 100%) (p=.18). 5-year graft patency also did not statistically differ between the three age groups (49.56%, 55.4%, 80%) (p=.1).Conclusion: Splice vein bypass remains an effective and viable option for conduit limited patients with chronic limb ischemia. Similar rates of major amputation and long-term survival between the splice vein bypass groups appears to justify aggressive limb salvage in even the extreme age patients.
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