PMID- 35672107
OWN - NLM
STAT- MEDLINE
DCOM- 20220609
LR  - 20220609
IS  - 1558-4518 (Electronic)
IS  - 0895-7967 (Linking)
VI  - 35
IP  - 2
DP  - 2022 Jun
TI  - Optimal conduit choice for open lower extremity bypass in chronic 
      limb-threatening ischemia.
PG  - 172-179
LID - S0895-7967(22)00033-3 [pii]
LID - 10.1053/j.semvascsurg.2022.05.001 [doi]
AB  - Open bypass surgery remains a major tool for limb salvage in chronic 
      limb-threatening ischemia (CLTI). Although rest pain and tissue loss both fall 
      into the category of CLTI, goals of revascularization are markedly different for 
      each context. Rest pain mandates long-term patency considerations. Tissue loss, 
      however, requires consideration of infection risks and patency enough to heal the 
      wound. Of the major conduit options, autologous saphenous vein graft continues to 
      be the conduit of choice, given both superior patency and low risk of infection. 
      When saphenous vein graft is not available or not available in appropriate 
      length, arm vein, small saphenous vein, and spliced combinations of these have 
      acceptable patency rates. Heparin-bonded polytetrafluoroethylene and Dacron 
      grafts are prosthetic conduits with excellent patency rates when vein is not 
      available. For infected wounds without other options, cryovein continues to 
      provide acceptable patency for limb salvage. Creation of a bypass is only part of 
      CLTI management. Appropriate postoperative surveillance with noninvasive studies, 
      including ankle-brachial index and duplex ultrasound, can alert to impending 
      graft failure, with a drop in ankle-brachial index of 0.15 and velocity ratios of 
      3 or more suggestive of significant stenoses. Anticoagulation has only been found 
      in limited contexts (such as poor conduit or poor outflow) to offer some patency 
      benefit, however, findings from the VOYAGER PAD (Vascular Outcomes Study of ASA 
      [Acetylsalicylic Acid] Along With Rivaroxaban in Endovascular or Surgical Limb 
      Revascularization for PAD) trial were a major breakthrough, showing a reduction 
      in the composite outcome of major adverse limb, cardiac, and cerebrovascular 
      events in revascularized patients taking low-dose rivaroxaban in conjunction with 
      aspirin, without a substantial increase in bleeding risk.
CI  - Copyright (c) 2022. Published by Elsevier Inc.
FAU - Thomas, Jones P
AU  - Thomas JP
AD  - Department of Surgery, Division of Vascular Surgery and Endovascular Therapies, 
      University Hospitals Cleveland Medical Center, Case Western University, 
      Cleveland, OH.
FAU - So, Kristine L
AU  - So KL
AD  - Department of Surgery, Division of Vascular Surgery and Endovascular Therapies, 
      University Hospitals Cleveland Medical Center, Case Western University, 
      Cleveland, OH.
FAU - Turner, Jason T
AU  - Turner JT
AD  - Department of Surgery, Division of Vascular Surgery and Endovascular Therapies, 
      University Hospitals Cleveland Medical Center, Case Western University, 
      Cleveland, OH.
FAU - Malanowski, Alexander J
AU  - Malanowski AJ
AD  - Department of Surgery, Division of Vascular Surgery and Endovascular Therapies, 
      University Hospitals Cleveland Medical Center, Case Western University, 
      Cleveland, OH.
FAU - Colvard, Benjamin D
AU  - Colvard BD
AD  - Department of Surgery, Division of Vascular Surgery and Endovascular Therapies, 
      University Hospitals Cleveland Medical Center, Case Western University, 
      Cleveland, OH. Electronic address: Benjamin.colvard@uhhospitals.org.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20220507
PL  - United States
TA  - Semin Vasc Surg
JT  - Seminars in vascular surgery
JID - 8809602
RN  - 9NDF7JZ4M3 (Rivaroxaban)
SB  - IM
MH  - *Chronic Limb-Threatening Ischemia
MH  - Humans
MH  - *Ischemia/diagnostic imaging/surgery
MH  - Limb Salvage
MH  - Lower Extremity/blood supply
MH  - Pain/surgery
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Rivaroxaban
MH  - Saphenous Vein/diagnostic imaging/surgery
MH  - Treatment Outcome
MH  - Vascular Patency
EDAT- 2022/06/08 06:00
MHDA- 2022/06/10 06:00
CRDT- 2022/06/07 21:04
PHST- 2022/03/06 00:00 [received]
PHST- 2022/05/02 00:00 [revised]
PHST- 2022/05/02 00:00 [accepted]
PHST- 2022/06/07 21:04 [entrez]
PHST- 2022/06/08 06:00 [pubmed]
PHST- 2022/06/10 06:00 [medline]
AID - S0895-7967(22)00033-3 [pii]
AID - 10.1053/j.semvascsurg.2022.05.001 [doi]
PST - ppublish
SO  - Semin Vasc Surg. 2022 Jun;35(2):172-179. doi: 10.1053/j.semvascsurg.2022.05.001. 
      Epub 2022 May 7.