Reintervention and mortality after infrainguinal reconstructive surgery for leg ischaemia

Background: Progression of atherosclerosis and graft‐related complications are common indications for late vascular intervention. The aim of this study was to determine the cumulative risk of late reintervention or death after infrainguinal bypass grafting. Methods: Some 205 consecutive patients wit...

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Bibliographic Details
Published in:British journal of surgery 1999-01, Vol.86 (1), p.38-44
Main Authors: Dawson, I., van Bockel, J. H.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Amputation - methods
Biological and medical sciences
Blood Vessel Prosthesis Implantation
Female
Graft Occlusion, Vascular - etiology
Humans
Ischemia - surgery
Leg - blood supply
Male
Medical sciences
Middle Aged
Prospective Studies
Reconstructive Surgical Procedures - methods
Recurrence
Reoperation
Risk Factors
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Survival Analysis
Treatment Outcome
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
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Summary:Background: Progression of atherosclerosis and graft‐related complications are common indications for late vascular intervention. The aim of this study was to determine the cumulative risk of late reintervention or death after infrainguinal bypass grafting. Methods: Some 205 consecutive patients with limb‐threatening ischaemia were included. All data were recorded prospectively. The principal endpoint was reintervention for a graft‐related complication or recurrent leg ischaemia. Mean follow‐up was 3·3 years. Life‐table and multivariate analyses were employed to estimate the cumulative risk of reintervention or death during follow‐up and to assess factors influencing this risk. Results: Beyond 30 days after insertion of the infrainguinal bypass, 67 patients (33 per cent) had 112 subsequent vascular interventions in the ipsilateral extremity. The cumulative reintervention rate was 25 per cent at 1 year and 40 per cent at 5 years. Poor run‐off (P < 0·005) and prosthetic grafts (P < 0·001) were significant and independent risk factors. Long‐term survival was poor and affected by the presence of diabetes (P < 0·01) and renal insufficiency (P < 0·01). Conclusion: Late reinterventions are common after infrainguinal bypass for limb‐threatening ischaemia, and contribute to morbidity and discomfort. Such information is of particular relevance to patients in high‐risk groups and should be explained as an integral part of informed consent. © 1999 British Journal of Surgery Society Ltd
ISSN:0007-1323
1365-2168
DOI:10.1046/j.1365-2168.1999.00970.x