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Abdul-Malak OM, Semaan DB, Madigan MC, Sridharan ND, Chaer RA, Siracuse JJ, Eslami MH. Midterm Outcomes and Predictors of Failure of Lower Extremity Bypass to Para-Malleolar and Pedal Targets. Ann Vasc Surg 2024; 106:227-237. [PMID: 38815913 DOI: 10.1016/j.avsg.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The frequency of distal lower extremity bypass (LEB) for infrapopliteal critical limb threatening ischemia (IP-CLTI) has significantly decreased. Our goal was to analyze the contemporary outcomes and factors associated with failure of LEB to para-malleolar and pedal targets. METHODS We queried the Vascular Quality Initiative infrainguinal database from 2003 to 2021 to identify LEB to para-malleolar or pedal/plantar targets. Primary outcomes were graft patency, major adverse limb events [vascular reintervention, above ankle amputation] (MALE), and amputation-free survival at 2 years. Standard statistical methods were utilized. RESULTS We identified 2331 LEB procedures (1,265 anterior tibial at ankle/dorsalis pedis, 783 posterior tibial at ankle, 283 tarsal/plantar). The prevalence of LEB bypasses to distal targets has significantly decreased from 13.37% of all LEB procedures in 2003-3.51% in 2021 (P < 0.001). The majority of cases presented with tissue loss (81.25. Common postoperative complications included major adverse cardiac events (8.9%) and surgical site infections (3.6%). Major amputations occurred in 16.8% of patients at 1 year. Postoperative mortality at 1 year was 10%. On unadjusted Kaplan-Meier survival analysis at 2 years, primary patency was 50.56% ± 3.6%, MALE was 63.49% ± 3.27%, and amputation-free survival was 71.71% ± 0.98%. In adjusted analyses [adjusted for comorbidities, indication, conduit type, urgency, prior vascular interventions, graft inflow vessel (femoral/popliteal), concomitant inflow procedures, surgeon and center volume] conduits other than great saphenous vein (P < 0.001) were associated with loss of primary patency and increased MALE. High center volume (>5 procedures/year) was associated with improved primary patency (P = 0.015), and lower MALE (P = 0.021) at 2 years. CONCLUSIONS Despite decreased utilization, open surgical bypass to distal targets at the ankle remains a viable option for treatment of IP-CLTI with acceptable patency and amputation-free survival rates at 2 years. Bypasses to distal targets should be performed at high volume centers to optimize graft patency and limb salvage and minimize reinterventions.
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Affiliation(s)
- Othman M Abdul-Malak
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA; MedStar Heart and Vascular Institute, Baltimore, MD.
| | - Dana B Semaan
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Michael C Madigan
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Natalie D Sridharan
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Rabih A Chaer
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston University, Boston, MA
| | - Mohammad H Eslami
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Charleston Area Medical Center, Charleston, WV
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Yu X, Wang B, Qiu C, He Y, Chen T, Zhu Q, Li Z, Wu Z. A systematic review and meta-analysis of primary bypass surgery compared with bypass surgery after endovascular treatment in peripheral artery disease patients. J Vasc Surg 2023; 78:1335-1345.e4. [PMID: 37453586 DOI: 10.1016/j.jvs.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/23/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Both bypass surgery and endovascular treatment are well-recognized interventions for the treatment of peripheral artery disease; however, the effect of failed endovascular treatment on subsequent surgeries remains controversial. A systematic review was conducted to compare the outcomes of primary bypass and bypass surgery after endovascular treatment. METHODS Three academic databases (Embase, PubMed, and Scopus) were searched from their inception to August 2022. Two independent investigators searched for studies that reported the outcomes of primary bypass surgery and bypass surgery after endovascular treatment in patients with peripheral artery disease. Abstracts and full-text studies were screened independently using duplicate data abstraction. Dichotomous outcome measures were reported using a random-effects model to generate a summary odds ratio (OR) and 95% confidence interval (CI). The risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS Seventeen retrospective observational studies were selected from 3911 articles and included 8064 patients, 6252 of whom underwent primary bypass surgery and 1812 underwent bypass surgery after endovascular treatment. The mean age was 69.0 years and 61.2% (n = 4938) were male. For perioperative outcomes, the 30-day results showed no difference in mortality (OR, 0.76; 95% CI, 0.53-1.10), or amputation (OR, 0.89; 95% CI, 0.67-1.20). For short- to mid-term outcomes, primary patency did not differ at 6 months (OR, 0.98; 95% CI, 0.81-1.19), 1 year (OR, 1.12; 95% CI, 0.97-1.30), or 2 years (OR, 1.17; 95% CI, 0.85-1.61) follow-up. Amputation-free survival did not differ at 6 months (OR, 1.03; 95% CI, 0.82-1.30), 1 year (OR, 1.09; 95% CI, 0.89-1.32), 2 years (OR, 1.18; 95% CI, 0.93-1.50), or 3 years (OR, 1.09; 95% CI, 0.84-1.40) of follow-up. No significant difference was found in overall survival or second patency. CONCLUSIONS This meta-analysis of retrospective, nonrandomized, observational studies suggests that prior endovascular treatment of lower extremity arterial disease does not result in worse perioperative, short-term, or mid-term clinical outcomes of subsequent infrainguinal bypass surgery compared with patients without prior endovascular treatment.
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Affiliation(s)
- Xinyu Yu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bing Wang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tianchi Chen
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qianqian Zhu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhenjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Troisi N, Michelagnoli S, Adami D, Berchiolli R. Comparison of long occlusive femoro-popliteal de novo vs. previous endovascularly treated lesions managed with in situ saphenous bypass. J Vasc Surg 2022; 76:797-805. [PMID: 35561942 DOI: 10.1016/j.jvs.2022.03.884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/29/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The aim of this study was to compare two-year outcomes of de novo vs. post-endovascular lesion treatment of femoro-popliteal occlusions included in a national, multicenter, observational, prospective registry based on the treatment of critical Limb-threatening IschaeMia with infragenicular Bypass adopting in situ SAphenous VEin technique (LIMBSAVE). METHODS From January 2018 until December 2019, 541 patients from 43 centers have been enrolled in the LIMBSAVE registry. Of these patients, 460 were included in the present study: 341 (74.1%) with de novo lesions (Group DN) and 119 (25.9%) with post-endovascular treatment lesions (Group PE). Initial outcome measures were assessed at 30 days post-treatment. Furthermore, at 2-year follow-up, estimated outcomes of primary patency, primary assisted patency, secondary patency, and limb salvage were analyzed with Kaplan-Meier curves and compared between groups with the log-rank test. RESULTS Both groups were homogeneous in terms of demographic data, preoperative risk factors, and clinical presentation. However, compared to Group DN, more patients in Group PE had a great saphenous vein diameter of < 3 mm (11.1% vs. 21%; P=0.007). Intraoperatively, both groups showed similar distal anastomosis sites: below-the-knee popliteal artery (63% Group DN, 66.4% Group PE) and tibial vessel (37% Group DN, 33.6% Group PE) (P=0.3). Overall mean duration of follow-up was 11.6 months (range 1-24). At 2-year follow-up there were no differences between the two groups in terms of primary patency (66.3% Group DN vs. 74.1% Group PE, P=0.9), primary assisted patency (78.2% Group DN vs. 79.5% Group PE, P=0.2), secondary patency (85.1% Group DN vs. 91.4% Group PE, P=0.2), and limb salvage (95.2% Group DN vs. 95.1% Group PE, P=0.9). CONCLUSIONS The LIMBSAVE registry did not show a worsening of overall patency and limb salvages rates at the 2-year follow-up in patients undergoing in situ saphenous bypass after a failed endovascular approach for long femoro-popliteal occlusive disease. This is in contrast to what has been published in literature.
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Affiliation(s)
- Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Stefano Michelagnoli
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Daniele Adami
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Kim Y, Decarlo CS, Thangappan K, Zacharias N, Mohapatra A, Dua A. Distal Bypass Versus Infrageniculate Endovascular Intervention for Chronic Limb-Threatening Ischemia. Vasc Endovascular Surg 2022; 56:539-544. [PMID: 35356834 DOI: 10.1177/15385744221086347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic limb-threatening ischemia (CLTI) carries a high risk of amputation and warrants urgent intervention. CLTI involving the infrageniculate vessels, in particular, carries a considerably higher risk of major limb amputation. Open surgical bypass is the historical gold standard for the treatment of tibial arterial disease; however, endovascular therapy provides an attractive alternative in this high-risk patient population. In this article, we review the existing literature regarding distal bypass and infrageniculate endovascular intervention in patients with CLTI.
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Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA. USA
| | - Charles S Decarlo
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA. USA
| | - Karthik Thangappan
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA. USA
| | - Nikolaos Zacharias
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA. USA
| | - Abhisekh Mohapatra
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA. USA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA. USA
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Altable García M, Chiriboga Granja JI, Reviriego Eíros M, Zaragozá García JM, Plaza Martinez Á, Martinez Perelló I, Gómez Palonés FJ. Could prior endovascular interventions affect the results of lower extremity below the knee autologous vein bypasses? INT ANGIOL 2021; 40:315-322. [PMID: 33870675 DOI: 10.23736/s0392-9590.21.04542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Performing a non-selective primary endovascular approach involves risk of performing ineffective procedures and could compromise future treatments. The objective of this research is to determine if previous failed endovascular intervention could affect bypass results. METHODS Retrospective cohort study including 77 below the knee (BTK) bypasses with great saphenous vein (GSV) in patients with critical limb ischemia, carried out between 2008-2018. Primary bypasses (P-BP) were compared with bypasses with history of previous failed endovascular intervention (Secondary bypasses [S-BP]). Primary outcomes included: primary, primary-assisted, and secondary patency, and major amputation-free survival (AFS). The quality of GSV used was evaluated as a potential confounding factor. RESULTS Forty-six procedures were P-BP (59.7%) and 31 S-BP (40.3%). The mean follow-up was 35.4 (SD: 31) and 28 (DS: 30) months respectively. Univariate results showed an increased risk of loss of primary patency (HR=2.7), primary-assisted patency (HR=3.1) and secondary patency (HR=3.26) in S-BP (P<0.05). This group also presented a trend towards an increased risk of major amputation (HR=1.6; P>0.05). Suboptimal GSV was used in 29% of S-BP and 15% of P-BP. This factor was identified as confounding partially, as it decreased the influence assumed by the history of prior endovascular intervention in the analyzed variables. CONCLUSIONS Secondary bypasses show inferior results to primary bypasses in our series. Although the cause could be a prior failed endovascular intervention, the frequent use of suboptimal GSV in this type of patients may also contribute to this effect.
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Affiliation(s)
- Mario Altable García
- Department of Vascular and Endovascular Surgery, Dr. Peset University Hospital, Valencia, Spain -
| | - Jose I Chiriboga Granja
- Department of Vascular and Endovascular Surgery, Dr. Peset University Hospital, Valencia, Spain
| | - Mario Reviriego Eíros
- Department of Biodiversity, Ecology and Evolution, Complutense University of Madrid, Madrid, Spain.,Smart Intelligence Services (SAITS), Madrid, Spain
| | - José M Zaragozá García
- Department of Vascular and Endovascular Surgery, Dr. Peset University Hospital, Valencia, Spain
| | - Ángel Plaza Martinez
- Department of Vascular and Endovascular Surgery, Dr. Peset University Hospital, Valencia, Spain
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Editor's Choice – Infrainguinal Bypass Following Failed Endovascular Intervention Compared With Primary Bypass: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2019; 57:382-391. [DOI: 10.1016/j.ejvs.2018.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/20/2018] [Indexed: 11/23/2022]
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