PMID- 33549802
OWN - NLM
STAT- MEDLINE
DCOM- 20211220
LR  - 20211220
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 74
DP  - 2021 Jul
TI  - Role of Bypass with Preoperatively Diagnosed Small Caliber Veins in Chronic 
      Limb-Threatening Ischemia.
PG  - 344-355
LID - S0890-5096(21)00100-X [pii]
LID - 10.1016/j.avsg.2020.12.040 [doi]
AB  - BACKGROUND: In chronic limb-threatening ischemia (CLTI), although recent studies 
      suggested that limbs classified as a higher Wound, Ischemia, foot Infection 
      (WIfI) stage would benefit more from bypass surgery than endovascular therapy 
      (EVT), graft unavailability is a major limitation for bypass. However, such graft 
      unavailability is not clearly defined. This study aimed to assess whether bypass 
      with veins judged as small by preoperative ultrasound is acceptable to achieve 
      wound healing. METHODS: Ninety-five limbs classified as WIfI stage 3/4 that 
      underwent infrainguinal bypass with veins were enrolled and divided into two 
      groups based on the preoperative inner diameter of veins. Those with a diameter 
      <2.5 mm were classified as small caliber grafts (SMGs, n=28) and those with a 
      diameter >/=2.5 mm as sufficient caliber grafts (SUGs, n=67), and wound-related 
      outcomes were evaluated. Wound healing rate (WHR) was analyzed in all cohort, and 
      wound recurrence-free rate (WRF) and wound recurrence-free amputation-free 
      survival rate (WRAFS) were calculated for limbs that achieved wound healing. A 
      propensity score matched analysis was also performed to minimize the background 
      difference, and 21 matched pairs were included for the analysis. RESULTS: 
      Although the primary patency rate was significantly worse in SMGs (1-year 
      patency, Crude model: 82.1% in SUGs and 51.0% in SMGs, P=0.0003; matched model: 
      77.7% in SUGs and 41.6% in SMGs, P = 0.005), the secondary patency rate was 
      maintained in the equivalent level (1-year patency, Crude model: 81.8% in SUGs 
      and 83.1% in SMGs, P=0.26; matched model: 77.7% in SUGs and 78.4% in SMGs, 
      P = 0.24). One-year WHR was equivalent between the groups in both crude and 
      matched models (Crude model: 87.0% in SUGs and 83.8% in SMGs, P=0.13; matched 
      model: 66.3% in SUGs and 61.4% in SMGs, P = 0.65). One-year WRF and WRAFS were 
      also equivalent (Crude model: WRF, 95.9% in SUGs and 100% in SMGs, P = 0.71; 
      WRAFS, 87.2% in SUGs and 88.0% in SMGs, P = 0.78. Matched model: WRF, 100% in 
      SUGs and 100% in SMGs, P = 0.85; WRAFS, 92.9% in SUGs and 78.6% in SMGs, 
      P = 0.38). CONCLUSIONS: Although bypass with small caliber veins showed an 
      inferior primary patency rate, WHR and WRF were equally good if grafts are 
      maintained patent. Bypass with small caliber vein grafts would be an important 
      option to achieve wound healing.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Miyake, Keisuke
AU  - Miyake K
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Osaka, Japan; Department of Vascular Surgery, Japan Organization 
      of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan.
FAU - Nakamura, Takashi
AU  - Nakamura T
AD  - Department of Vascular Surgery, Japan Organization of Occupational Health and 
      Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan. Electronic address: 
      takashin@mvd.biglobe.ne.jp.
FAU - Fujimura, Hironobu
AU  - Fujimura H
AD  - Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, Toyonaka, 
      Osaka, Japan.
FAU - Shibuya, Takashi
AU  - Shibuya T
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Osaka, Japan.
FAU - Sawa, Yoshiki
AU  - Sawa Y
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Osaka, Japan.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20210204
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Chronic Limb-Threatening Ischemia/*surgery
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Limb Salvage/methods/statistics & numerical data
MH  - Lower Extremity/*blood supply
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Vascular Grafting/*methods
MH  - Vascular Patency
MH  - Veins/*transplantation
MH  - Wound Healing
EDAT- 2021/02/08 06:00
MHDA- 2021/12/21 06:00
CRDT- 2021/02/07 20:34
PHST- 2020/10/29 00:00 [received]
PHST- 2020/12/18 00:00 [revised]
PHST- 2020/12/22 00:00 [accepted]
PHST- 2021/02/08 06:00 [pubmed]
PHST- 2021/12/21 06:00 [medline]
PHST- 2021/02/07 20:34 [entrez]
AID - S0890-5096(21)00100-X [pii]
AID - 10.1016/j.avsg.2020.12.040 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2021 Jul;74:344-355. doi: 10.1016/j.avsg.2020.12.040. Epub 2021 
      Feb 4.