Ann Surg Treat Res.  2021 Mar;100(3):175-185. 10.4174/astr.2021.100.3.175.

Factors associated with long-term graft patency after lower extremity arterial bypasses

• Jung KS
• Heo SH
• Woo SY
• Park YJ
• Kim DI
• Kim YW

• KMID: 2513198
• DOI: http://doi.org/10.4174/astr.2021.100.3.175

Abstract

Purpose
This study was conducted to determine factors associated with long-term graft patency after lower extremity arterial bypass (LEAB).
Methods
Database of LEABs for patients with chronic arterial occlusive disease (CAOD) at a single institution was retrospectively reviewed. To determine the factors we compared demographic, clinical, and procedural variables between 2 patient groups; group I (graft patency < 2 years) and group II (graft patency ≥ 5 years after LEAB) using univariable and multivariable analyses.
Results
Among 957 LEABs, 259 limbs (group I, 125 limbs and group II, 134 limbs) in 213 patients were included for the analysis. On a univariable analysis, younger age (69 years vs. 66 years, P = 0.024), hypertension (60.8% vs. 74.6%, P = 0.017), claudication (51.2% vs. 70.9%, P = 0.001), absence of prior intervention (50.4% vs. 73.9%, P < 0.001), common femoral artery based bypass (57.6% vs. 70.1%, P = 0.035), above-the knee bypass (36.8% vs. 64.2%, P < 0.001), postoperative graft salvage procedure (3.2% vs. 14.8%, P = 0.001), and statin use (75.2% vs. 88.8, P = 0.004) were associated with long-term patency. On a multivariate analysis hypertension (odds ratio [OR], 1.91; P = 0.038), claudication (OR, 2.08; P = 0.032), no prior intervention (OR, 2.48; P = 0.001), vein graft (OR, 4.36; P = 0.001), above-the knee bypass (OR, 4.68; P < 0.001), and graft salvage procedures (OR, 7.70; P < 0.001) were identified as independent factors.
Conclusion
These factors can be considered in decision making before treatment of patients with CAOD.

Keyword

Arterial bypass; Graft patency; Lower extremity; Peripheral arterial disease

Figure

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  Fig. 1 Scheme of comparative study to determine factors associated with long-term graft patency after lower extremity arterial bypasses.

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  Fig. 2 Patient inclusion for a comparative study. Group I, limbs showed graft occlusion within 2 years after lower extremity arterial bypass (LEAB); group II, limbs showed patent graft for longer than 5 years after LEAB.

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  Fig. 3 Kaplan-Meier curves of the factors associated with long-term graft patency after lower extremity arterial bypass on multivariate analysis (all P-values are acquired through log-rank test). (A) Age (<80 years vs. ≥80 years), (B) claudication vs. critical limb ischemia, (C) hypertension vs. normotension, (D) vein graft vs. prosthetic graft, (E) anastomosis level (above-the-knee vs. below-the-knee), (F) graft salvage procedure, and (G) prior intervention of index artery.

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