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Autogenous Patch Angioplasty With Saphenofemoral Junction As An Additional Benefit Of In Situ Bypass
Xander Jacobson, MD, Elizabeth Pinchman, B.S., Jeffrey C. Hnath, MD, R. Clement Darling III, MD;
Albany Medical College, Albany, NY, USA

OBJECTIVES: In situ bypass for lower extremity ischemia is an effective and durable procedure. One of the benefits of this type of bypass is the ability to use a cuff of the femoral vein at the saphenofemoral junction as a patch angioplasty for the closure of the femoral artery. The purpose of this study is to evaluate outcomes for lower extremity in-situ bypass with and without femoral endarterectomy and using the hood of the femoral vein as a patch angioplasty versus a prosthetic patch after endarterectomy. METHODS: A search of the database of a single academic center vascular group for patients undergoing an in-situ bypass of the lower extremities with and without femoral endarterectomy (ISB) and the use of patch (ISBP) or vein cuff (ISBV) for endarterectomy closure between 1/1/2013 and 12/31/2022. Data collected included demographics, indication, operative details, and outcomes. The groups were compared using standard statistical analysis. RESULTS: 1750 lower extremity in-situ bypasses were performed [1155 (66%) ISB, 429 (24.5%) ISBV, 166 (9.5% ISBP)] of which 1181 (67.5%) were male with an average age of 68 (range 22-98). Comorbidities were similar except for more coronary disease (p=0.018) and pulmonary disease in the ISBP (p=0.024). Indications: claudication 385 (22%), rest pain 440 (25.1%), non-healing ulcer 416 (23.8%), gangrene 415 (23.7%), other 94 (5.37%). Superficial femoral artery as inflow was significantly higher in ISB vs ISBP/ISBV (p<.0001). Anterior tibial artery as outflow was higher in ISB vs ISBP/ISBV (p=.024). Perioperative mortality was similar between groups (p=.699). Readmission rates trended higher in ISBP (p=.052) and post-operative infections were similar (p=.107). Lymphoceles and seromas were significantly higher in ISBP (p=.0013). Early occlusion rates were higher in ISB (p=.037), but overall revision rates were not significant ( p=.082). Major amputation rates were similar among groups (p= .234). CONCLUSIONS: In situ bypass has proven to offer excellent limb salvage and patency rates. One of the added benefits is the ability to use a cuff of femoral vein at the saphenofemoral junction as a patch angioplasty after femoral endarterectomy. This series demonstrates that the use of the femoral vein cuff as an autogenous patch angioplasty offers equivalent patency and limb salvage outcomes compared to prosthetic patch and may offer a benefit in terms of lymphatic complications.
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