PMID- 38310981
OWN - NLM
STAT- Publisher
LR  - 20240302
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
DP  - 2024 Feb 2
TI  - Predictors of amputation-free survival and wound healing after infrainguinal 
      bypass with alternative conduits.
LID - S0741-5214(24)00269-6 [pii]
LID - 10.1016/j.jvs.2024.01.209 [doi]
AB  - OBJECTIVE: Inadequate vein quality or prior harvest precludes use of autologous 
      single segment greater saphenous vein (ssGSV) in many patients with chronic 
      limb-threatening ischemia (CLTI). Predictors of patient outcome after 
      infrainguinal bypass with alternative (non-ssGSV) conduits are not 
      well-understood. We explored whether limb presentation, bypass target, and 
      conduit type were associated with amputation-free survival (AFS) after 
      infrainguinal bypass using alternative conduits. METHODS: A single-center 
      retrospective study (2013-2020) was conducted of 139 infrainguinal bypasses 
      performed for CLTI with cryopreserved ssGSV (cryovein) (n = 71), 
      polytetrafluoroethylene (PTFE) (n = 23), or arm/spliced vein grafts (n = 45). 
      Characteristics, Wound, Ischemia, and foot Infection (WIfI) stage, and outcomes 
      were recorded. Multivariable Cox proportional hazards and classification and 
      regression tree analysis modeled predictors of AFS. RESULTS: Within 139 cases, 
      the mean age was 71 years, 59% of patients were male, and 51% of cases were 
      nonelective. More patients undergoing bypass with cryovein were WIfI stage 4 
      (41%) compared with PTFE (13%) or arm/spliced vein (27%) (P = .04). Across 
      groups, AFS at 2 years was 78% for spliced/arm, 79% for PTFE, and 53% for 
      cryovein (adjusted hazard ratio for cryovein, 2.5; P = .02). Among cases using 
      cryovein, classification and regression tree analysis showed that WIfI stage 3 or 
      4, age >70 years, and prior failed bypass were predictive of the lowest AFS at 
      2 years of 36% vs AFS of 58% to 76% among subgroups with less than two of these 
      factors. Although secondary patency at 2 years was worse in the cryovein group 
      (26% vs 68% and 89% in arm/spliced and PTFE groups; P < .01), in patients with 
      tissue loss there was no statistically significant difference in wound healing in 
      the cryovein group (72%) compared with other bypass types (72% vs 87%, 
      respectively; P = .12). CONCLUSIONS: In patients with CLTI lacking suitable 
      ssGSV, bypass with autogenous arm/spliced vein or PTFE has superior AFS compared 
      with cryovein, although data were limited for PTFE conduits for distal targets. 
      Despite poor patency with cryovein, wound healing is achieved in a majority of 
      cases, although it should be used with caution in older patients with high WIfI 
      stage and prior failed bypass, given the low rates of AFS.
CI  - Copyright (c) 2024 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Matthay, Zachary A
AU  - Matthay ZA
AD  - Department of Surgery, University of California, San Francisco, San Francisco, 
      CA.
FAU - Pace, William A
AU  - Pace WA
AD  - Department of Surgery, University of California, San Francisco, San Francisco, 
      CA. Electronic address: william.pace@ucsf.edu.
FAU - Smith, Eric J
AU  - Smith EJ
AD  - Department of Surgery, Division of Vascular and Endovascular Surgery, University 
      of California, San Francisco, San Francisco, CA.
FAU - Gutierrez, Richard D
AU  - Gutierrez RD
AD  - Department of Surgery, University of California, San Francisco, San Francisco, 
      CA.
FAU - Gasper, Warren J
AU  - Gasper WJ
AD  - Department of Surgery, Division of Vascular and Endovascular Surgery, University 
      of California, San Francisco, San Francisco, CA.
FAU - Hiramoto, Jade S
AU  - Hiramoto JS
AD  - Department of Surgery, Division of Vascular and Endovascular Surgery, University 
      of California, San Francisco, San Francisco, CA.
FAU - Reilly, Linda M
AU  - Reilly LM
AD  - Department of Surgery, Division of Vascular and Endovascular Surgery, University 
      of California, San Francisco, San Francisco, CA.
FAU - Conte, Michael S
AU  - Conte MS
AD  - Department of Surgery, Division of Vascular and Endovascular Surgery, University 
      of California, San Francisco, San Francisco, CA.
FAU - Iannuzzi, James C
AU  - Iannuzzi JC
AD  - Department of Surgery, Division of Vascular and Endovascular Surgery, University 
      of California, San Francisco, San Francisco, CA.
LA  - eng
PT  - Journal Article
DEP - 20240202
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
OTO - NOTNLM
OT  - Chronic limb-threatening ischemia
OT  - Limb salvage
OT  - Vascular grafting
COIS- Disclosures M.C. is an advisory board member for Abbott Vascular.
EDAT- 2024/02/05 00:42
MHDA- 2024/02/05 00:42
CRDT- 2024/02/04 19:27
PHST- 2023/09/28 00:00 [received]
PHST- 2024/01/24 00:00 [revised]
PHST- 2024/01/28 00:00 [accepted]
PHST- 2024/02/05 00:42 [pubmed]
PHST- 2024/02/05 00:42 [medline]
PHST- 2024/02/04 19:27 [entrez]
AID - S0741-5214(24)00269-6 [pii]
AID - 10.1016/j.jvs.2024.01.209 [doi]
PST - aheadofprint
SO  - J Vasc Surg. 2024 Feb 2:S0741-5214(24)00269-6. doi: 10.1016/j.jvs.2024.01.209.