PMID- 34606957 OWN - NLM STAT- MEDLINE DCOM- 20220307 LR - 20221207 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 75 IP - 3 DP - 2022 Mar TI - Contemporary outcomes of concomitant suprainguinal bypass with infrainguinal revascularization procedures in patients with chronic limb-threatening ischemia. PG - 989-997.e1 LID - S0741-5214(21)02175-3 [pii] LID - 10.1016/j.jvs.2021.08.105 [doi] AB - OBJECTIVE: Combined suprainguinal and infrainguinal revascularization is sometimes necessary in the treatment of patients with chronic limb-threatening ischemia (CLTI). However, data on outcomes of concomitant revascularization procedures are lacking. We studied the outcomes of patients with CLTI who underwent suprainguinal bypass (SIB) alone, SIB with concomitant infrainguinal bypass (IIB), and SIB with concomitant infrainguinal peripheral endovascular intervention (IIPVI). METHODS: We reviewed all patients in the Vascular Quality Initiative with CLTI who underwent SIB from January 2010 to June 2020. Logistic regression, Kaplan-Meier survival estimates, log-rank tests, and Cox regression were used to analyze outcomes. Outcomes were 30-day mortality, perioperative myocardial infarction, perioperative major amputation, 1-year amputation-free survival, and 5-year survival. RESULTS: Of 8037 patients included, 81.3% (n = 6537) underwent SIB alone, 9.7% (n = 783) underwent SIB+IIB, and 8.9% (n = 717) underwent SIB+IIPVI. The indication for surgery was rest pain in 5040 (62.5%) and tissue loss in 3031 (37.6%). There were no significant differences in 30-day mortality and perioperative myocardial infarction rates. However, there was 2.8-fold increased odds of perioperative major amputation in both SIB+IIPVI (odds ratio [OR], 2.76; 95% confidence interval [CI], 1.30-5.88; P = .008) and SIB+IIB (OR, 2.79; 95% CI, 1.38-5.54; P = .004) among patients with rest pain as compared with SIB alone. Comparing SIB+IIPVI with SIB alone, there were no significant differences in 1-year freedom from amputation and amputation-free survival. SIB+IIPVI was associated with a 27% increased risk of 5-year mortality (hazard ratio [HR], 1.27; 95% CI, 1.03-1.55; P = .035). Compared with SIB alone, SIB+IIB was associated with 97% increased risk of 1-year major amputation among patients with rest pain (HR, 1.97; 95% CI, 1.06-3.69; P = .033), but a 47% decreased risk of 1-year major amputation or death for patients with tissue loss (HR, 0.53; 95% CI, 0.37-0.78; P = .001). SIB+IIPVI, compared with SIB+IIB, was associated with a two-fold increased risk of 1-year major amputation or death (HR, 2.04; 95% CI, 1.04-2.23), P = .003) and a 52% increased risk of 5-year mortality (HR,1.52; 95% CI, 1.04-2.24; P = .032) among patients with tissue loss. CONCLUSIONS: This study shows that SIB with concomitant infrainguinal revascularization in patients with rest pain is associated with an increased risk of amputation, whereas SIB+IIB in patients with tissue loss is associated with decreased risk of amputation or death. SIB+IIB outperformed SIB+IIPVI in patients with tissue loss. SIB with infrainguinal revascularization should be limited in patients with rest pain in line with current guidelines, but SIB+IIB may be preferred in patients with tissue loss. CI - Copyright (c) 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Naazie, Isaac N AU - Naazie IN AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, Calif. FAU - Zarrintan, Sina AU - Zarrintan S AD - Division of Vascular & Endovascular Surgery, Department of General & Vascular Surgery, Tabriz University of Medical Sciences, Tabriz, Iran. FAU - Arhuidese, Isibor AU - Arhuidese I AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of South Florida, Tampa, Fla. FAU - Al-Nouri, Omar AU - Al-Nouri O AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, Calif. FAU - Abou-Zamzam, Ahmed AU - Abou-Zamzam A AD - Division of Vascular and Endovascular Surgery, Department of Surgery, Loma Linda University, Loma Linda, Calif. FAU - Malas, Mahmoud AU - Malas M AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, Calif. Electronic address: mmalas@uscd.edu. LA - eng PT - Comparative Study PT - Journal Article DEP - 20211001 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Aged MH - Amputation, Surgical MH - Canada MH - Chronic Limb-Threatening Ischemia/diagnostic imaging/mortality/physiopathology/*therapy MH - Databases, Factual MH - *Endovascular Procedures/adverse effects/mortality MH - Female MH - Humans MH - Limb Salvage MH - Male MH - Middle Aged MH - Progression-Free Survival MH - Registries MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - United States MH - *Vascular Grafting/adverse effects/mortality MH - Vascular Patency OTO - NOTNLM OT - Chronic limb-threatening ischemia OT - Concomitant bypass OT - Endovascular revascularization OT - Lower extremity OT - Open revascularization OT - Peripheral arterial disease EDAT- 2021/10/05 06:00 MHDA- 2022/03/08 06:00 CRDT- 2021/10/04 20:15 PHST- 2021/04/02 00:00 [received] PHST- 2021/08/30 00:00 [accepted] PHST- 2021/10/05 06:00 [pubmed] PHST- 2022/03/08 06:00 [medline] PHST- 2021/10/04 20:15 [entrez] AID - S0741-5214(21)02175-3 [pii] AID - 10.1016/j.jvs.2021.08.105 [doi] PST - ppublish SO - J Vasc Surg. 2022 Mar;75(3):989-997.e1. doi: 10.1016/j.jvs.2021.08.105. Epub 2021 Oct 1.