Predictors of Time to Graft Failure Following Infrainguinal Arterial Reconstruction

DOI: 10.4236/ss.2011.24036   PDF   HTML     4,130 Downloads   7,114 Views   Citations


Background and purpose Infrainguinal arterial reconstruction increases limb salvage rates, however, the fac- tors that predict time to graft failure remain ill-defined. The aim of this study was to define such predictors. Methods A retrospective analysis of infrainguinal arterial reconstructions performed for symptomatic pe- ripheral arterial disease refractory to medical/interventional therapies over a 6 year period was performed. Demographics and adverse outcomes were analysed and statistical significance was determined using Chi-squared analysis, the Student t test and the Wilcoxon signed-rank test. Main findings 170 procedures were analysed. The male to female ratio was 4:3. The median age was 70.1 years. The post-operative com- plication rate was 12%. On univariate analysis, female gender, the use of a synthetic graft, and the presence of critical ischaemia at the time of surgery were predictive of time to graft failure (ρ ≤ 0.05, ρ ≤ 0.03, ρ ≤ 0.02 respectively). On multivariate analysis, the 3 most significant predictors were the occurrence of a post-operative complication, female gender and a high ASA grade. The presence of diabetes mellitus and smoking did not adversely affect graft outcome, (ρ ≤ 0.23, ρ ≤ 0.20 respectively). Conclusion This study suggests that female gender adversely affects graft patency while a history of smoking and the presence of diabetes mellitus do not. Our findings also suggest that the occurrence of a post-operative complication, and a high ASA grade at time of surgery are additional important predictors of early and late graft failure.

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P. Hallihan, N. Choileain, E. Myers, H. Redmond and G. Fulton, "Predictors of Time to Graft Failure Following Infrainguinal Arterial Reconstruction," Surgical Science, Vol. 2 No. 4, 2011, pp. 166-172. doi: 10.4236/ss.2011.24036.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Kent KC, Whittemore AD, Mannick JA. Short-term and mid-term results of an all autogenous tissue policy for infrainguinal reconstruction. J Vasc Surg 1989; 9: 107-14.
[2] Taylor LM Jr, Edwards JM, Porter JM. Present status of reverse vein bypass grafting: five-year results of a modern series. J Vasc Surg 1990; 11: 193-206.
[3] Lau H, Cheng SW. Long term prognosis of femoropopliteal bypass: An analysis of 349 consecutive revascularisations. Anz J. Surg. (2001) 71, 335-340.
[4] Conte M, Belkin M, Upchurch GR, Mannick JA, Whittemore AD, Donaldson MC. Impact of increasing comorbidity on infrainguinal arterial reconstruction : a 20 yr perspective. Ann Surg. 2001; 445-452.
[5] Bell JB, Papp L, Bradbury AW. Bypass or angioplasty for severe limb ischaemia of the leg: the BASIL trial. In: Vascular and Endovascular Opportunities, RM Greenhalgh, JT Powell, AW Mitchell. Eds WB Saunders, London 2000; pp. 485-494.
[6] Raviola CA, Nichter LS, Baker JD, Busuttil RW, Machleder HI, Moore WS. Cost of treating advanced leg ischaemia: bypass graft vs. primary amputation. Arch Surg. 1988; 123: 495-496.
[7] Gupta SK, Veith FJ, Ascer E, et al. Cost factors in limb-threaten ischaemia due to infrainguinal arteriosclerosis. Eur J Vasc Surg. 1998; 2: 151-154.
[8] Budd JS, Brennan J, Beard JD, Warren H, Burton PR, Bell PR. Infrainguinal bypass surgery: factors determining late graft patency. Br J Surg 1990; 77: 1382-1387.
[9] Thomas B, Lacroix H, Nevelsteen A, Suy R. Factors influencing patency of infrainguinal bypasses with polytetrafluoroethylene. Acta Chir Belg. 1999 Oct; 99(5): 236-40.
[10] Becquemin JP, Haiduc F, Labastie J, Melliere D. Femoropopliteal in situ saphenous vein bypass: technical aspects and factors determining patency. Ann Vasc Surg. 1987 May; 1(4): 432-40.
[11] Magnant JG, Cronenwett JL, Walsh DB et al. Surgical treatment of infrainguinal arterial occlusive disease in women. J Vasc Surg 1993; 17: 67-78.
[12] Enzler MA, Ruoss M, Seifert B, Berger M. The influence of gender on the outcome of arterial procedures in the lower extremity. Eur J Vasc Endovasc Surg 1996; 11: 446-452.
[13] Luther M, Lepantalo M. Femorotibial reconstructions for chronic critical leg ischaemia: influence on outcome by diabetes. Eur J Vasc Endovasc Surg 1997; 13: 569-577.
[14] Sawaya JI, Jazra C, Eid EV, Sabra RF. Gender differences in the diagnosis and treatment of acute myocardial infarction in Lebanon. J Med Liban 1999; 47: 2-6.
[15] Maynard C, Litwin PE, Martin JS, Weaver WD. Gender differences in the treatment and outcome of acute myocardial infarction. Results from the Myocardial Infarction, Triage and Intervention Registry. Arch Intern Med 1992; 152: 972-6.
[16] Loop FD, Golding LR, MacMillan JP, Cosgrove DM, Lytle BW, Sheldon WC. Coronary artery surgery in women compared with men: analyses of risks and long-term results. J Am Coll Cardiol 1983; 1: 383-90.
[17] Tan ES, van der Meer J, Jan de Kam P, Dunselman PH, Mulder BJ, Ascoop CA, et al. Worse clinical outcome but similar graft patency in women versus men one year after coronary artery bypass graft surgery owing to an excess of exposed risk factors in women. J Am Coll Cardiol 1999; 34: 1760-8.
[18] Raine RA, Crayford TJ, Chan KL, Chambers JB. Gender differences in the treatment of patients with acute myocardial ischemia and infarction in England. Int J Technol Assess Health Care 1999; 15: 136-46.
[19] Callam MJ, Ruckley CV. The epidemiology of chronic venous disease. In: Tooke JE, Lowe GDO, eds. A Textbook of Vascular Medicine. London: Arnold, 1996: 562-579.
[20] Cronenwett JL, Magnant J. Gender difference in infrainguinal outcome arterial occlusive disease. In Current Critical Problems in Vascular Surgery 1994 Vol. 6. 30-37. Quality Medical Publishing, Inc.
[21] American Society of Anaesthesiologists, Inc. New classification of physical status. Anaesthesiology 1963; 24: 111.
[22] Prause G, Ratzenhofer-Comenda B, Pierer G, et al. Can ASA grade or Goldman’s cardiac risk index predict peri-operative mortality? Anaesthesia 1997; 52: 203-206.
[23] Karacagil S, Almgren B, Bolwold S et al. Comparative analysis of patency, limb salvage and survival in diabetic and nondiabetic patients undergoing infrainguinal bypass surgery. Diabetic Med. 1995; 12: 537-41.
[24] Akbari CM, Pomposelli FB, Gibbons GW et al. Lower extremity revascularization in diabetes: Late observations. Arch. Surg. 2000; 135: 452-6.
[25] Wolfe KD, Bruijnen H, Loeprecht H et al. Graft patency and clinical outcome of femorodistal arterial reconstruction in diabetic and non-diabetic patients: results of a multicentre comparative trial. Uer. J. Vasc Endovasc. Surg. 2003; 25: 229-34.
[26] Gahtan V, Harpavat M, Roberts AB, Kerstein MD. Impact of diabetes mellitus on infrainguinal bypass grafting. J. Diab. Comp. 1998; 12: 197-200.
[27] AhChong Ah Kian; Chiu Kai Ming; Wong Maket Wai Chun; Hui Hiu Kit; Yip Andrew Wai Chun. Diabetes and the outcome of infrainguinal bypass for critical limb ischaemia. ANZ journal of surgery 2004; 74(3): 129-33.
[28] Ameli FM, Stein M, Prosser RJ, Provan JL, Aro L. Effects of cigarette smoking on outcome of femoral popliteal bypass for limb salvage. J Cardiovasc Surg 1989; 30: 591-96.
[29] Wiseman S, Powell J, Greenhalgh R, McCollum C, Kenchington G, Alexander C, et al. The influence of smoking and plasma factors on prosthetic graft patency. Eur J Vasc Surg 1990; 4: 57-61.
[30] Wiseman S, Kenchington G, Dain R, Marshall CE, McCollum CN, Greenhalgh RM, et al. Influence of smoking and plasma factors on patency of femoropopliteal vein grafts. BMJ 1989; 299: 643-46.
[31] Sayers RD, Thompson MM, Dunlop P, London NJ, Bell PR. The fate of infrainguinal PTFE grafts and an analysis of factors affecting outcome. Eur J Vasc Surg 1994; 8: 607-10.
[32] Willigendael EM, Teijink JAW, Bartelink M-L, Kuiken BW, Boiten J, Moll FL, et al. The influence of smoking on the incidence and prevalence of peripheral arterial disease. J Vasc Surg 2004; 40: 1158-65.
[33] Management of peripheral arterial disease (PAD) Trans- Atlantic Inter-Society Consensus (TASC). J Vasc Surg 2000; 31: S1-S28.
[34] Willigendae EMl, Teijink JA, Bartelink ML,. Peters RG, Büller HR, Prins MH. Smoking and the patency of lower extremity bypass grafts: A meta-analysis. J Vasc Surg 2005; 42: 67-74.
[35] Quinones-Baldrich WJ, Martin-Paredero V, Baker JD, Busuttil RW, Machleder HI, Moore WS. Polytetrafluoroethylene grafts as the first-choice arterial substitute in femoropopliteal revascularization. Arch Surg 1984; 119: 1238-43.
[36] Prendiville EJ, Yeager A, O’Donnell TF, Coleman JC, Jaworek A, Callow AD, et al. Long-term results with the above-knee popliteal expanded polytetrafluoroethylene graft. J Vasc Surg 1990; 11: 517-24.
[37] Quinones-Baldrich WJ, Prego AA, Ucelay-Gomez R, Freischlag JA, Ahn SS, Baker JD, et al. Long-term results of infrainguinal revascularization with polytetrafluoroethylene: a ten-year experience. J Vasc Surg 1992; 16: 209-17.
[38] AbuRahma AF, Robison PA, Holt SM. Prospective controlled study of PTFE versus saphenous vein in claudicant patients with bilateral above knee femoropopliteal bypasses. Surgery 1999; 126: 594-602.
[39] Veith FJ, Gupta SK, Ascer E, et al. Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions. J Vasc Surg 1986; 3: 104-14.

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