Society For Clinical Vascular Surgery

Back to 2018 ePosters

Failed Prior Endovascular Intervention Do Not Affect Outcomes of Infra-Inguinal Bypasses for Critical Limb Ischemia
Kyongjune B. Lee, MD, Alexander Yang, BS, Anton Sidawy, MD, MPH, Richard Amdur, PhD, Robyn Macsata, MD, Bao-Ngoc Nguyen, MD.
The George Washington University Hospital, Washington, DC, USA.

Failed prior endovascular intervention could adversely affect the outcomes of subsequent infra-inguinal bypasses in the corresponding limb but this perception is not well supported in the literature due to conflicting data. This study addresses this controversial issue via analysis of a multicenter prospectively collected database.
Patients who underwent infra-inguinal bypass for critical limb ischemia were identified in the targeted ACS-NSQIP database from 2005 to 2015. These patients were stratified into four groups: first time femoral-popliteal bypass (FemPop), femoral-popliteal bypass after failed endovascular revascularization (Endo-FemPop), first time femoral-tibial bypass (FemTib), and femoral-tibial bypass after failed endovascular revascularization (Endo-FemTib). Thirty-day outcomes including mortality, graft patency, major amputations and major organ dysfunction were measured. Multivariate logistic regression model was used for data analysis; power was 80% to detect a difference in incidence of 1.25% for FemPop and 1.9% for FemTib.
We identified 6720 patients who underwent surgery for critical limb ischemia: 3743 FemPop, 944 Endo-FemPop, 1559 Fem-Tib, and 474 Endo-FemTib. Patients were mostly matched among four groups except for minor differences in sex, hypertension, and pre-operative renal function. As the table shows, paired comparison between FemPop and Endo-FemPop revealed no significant differences in 30-day mortality, loss of patency, major amputation, or major organ dysfunction. However, Endo-FemPop significantly required more transfusion than FemPop. Similarly, there were no significant differences in 30-day outcomes between FemTib and Endo-FemTib in mortality, graft patency, amputation, and other major organ dysfunction. Endo-FemTib also had significantly higher transfusion rate than FemTib (Table).
Failed prior endovascular intervention generally does not adversely affect 30-day outcomes of infra-inguinal bypasses. Increase in transfusion requirements in bypass after failed endovascular intervention is likely related to increased surgical complexity. More data on long-term follow up is needed.
Table: 30-day Outcomes of Infra-Inguinal Bypass After Failed Endovascular Revascularization

OutcomesFemPop (n=3743)Endo-FemPop (n=944)ORp
Mortality41 (1.1%)7 (0.7%)0.64 (0.29 - 1.45)0.34
Cardiac*95 (2.5%)28 (3%)1.14 (0.74 - 1.76)0.55
Pulmonary**82 (2.2%)16 (1.7%)0.68 (0.39 -1.17)0.16
Renal Dysfunction31 (0.8%)7 (0.7%)0.81 (0.35 - 1.85)0.61
Amputation68 (2.3%)15 (2.0%)0.84 (0.48 - 1.49)0.56
Loss of Patency45 (1.2%)16 (1.7%)1.54 (0.86 - 2.75)0.14
Transfusion642 (17.2%)212 (22.5%)1.39 (1.14 - 1.71)<0.01
OutcomesFemTib (n=1559)Endo-FemTib (n=474)ORp
Mortality24 (1.5%)5 (1.1%)0.76 (0.28 - 2.03)0.58
Cardiac*64 (4.1%)23 (4.9%)1.36 (0.82 - 2.25)0.23
Pulmonary**50 (3.2%)16 (3.4%)1.16 (0.65 - 2.08)0.62
Renal Dysfunction24 (1.5%)4 (0.8%)0.54 (0.18 - 1.57)0.25
Amputation55 (4.5%)15 (4%)0.94 (0.52 - 1.70)0.84
Loss of Patency40 (2.6%)9 (1.9%)0.67 (0.32 - 1.41)0.29
Transfusion438 (28.9%)174 (36.7%)1.42 (1.13 - 1.79)<0.01

*Cardiac = MI, cardiac arrest
**Pulmonary = Pneumonia, Reintubation, prolonged ventilation > 48 hours

Back to 2018 ePosters
Private Dining Room
Las Vegas Downtown