The Outcome Analysis of Reintervention for the Infrainguinal Bypasses

Rhew, Young Ho; Jun, Soo Han; Kim, Young Wook

Abstract

Retrospective analysis of reinterventions for the failed or failing infrainguinal bypass grafts were carried out to observe the outcomes and to analyze the factors impacting the outcomes of the reinterventions. During the period of 5 years, 30(16.6%) reinterventions were performed at Department of Surgery, Kyungpook National University Hospital following 181 infrainguinal bypasses for 150 patients with chronic arterial occlusive disease. The indications for the reinterventions were recurrent claudication (23.3%), rest pain (60%), ulcer or gangrene (10%), and graft infection (3.3%). The angiographic findings were categorized as graft occlusion(16), stenosis of the bypass graft or anastomotic sites(8) and inflow or run-off artery occlusive lesion(5). The reintervention procedures were surgical in 27 limbs and percutaneous transluminal angioplasty(PTA) in 3 limbs. To observe the outcomes of reinterventions, the initial technical success, requirement of further interventions, and overall limb salvage rates were analyzed according to the time intervals between primary bypasses and reintervention, reintervention procedures and types of the lesions. The overall limb salvage rates after 30 reinterventions were 83.3% with mean follow-up of 28.6 months. We observed the limb salvage rate was lower after reintervention for the patients with total graft occlusion compared to stenotic lesion(75 % vs 100% p=0.26 ), prosthetic graft occlusion(75%), infrapopliteal bypass as a primary bypass, and patients who underwent early within 30 days reintervention after primary bypasses(60%). However, further investigation is required to get statistical acceptance.