| Risk factors for autogenous infrainguinal bypass occlusion in patients with prosthetic inflow grafts. | |
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MedLine Citation:
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PMID: 14743133 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: In patients with prosthetic inflow (PI) grafts the proximal anastomosis of autogenous infrainguinal bypass (AIB) can be placed on the PI or on a distal native vessel in the groin. This study was performed to determine the effect of placement of an AIB proximal anastomotic site in a patient with ipsilateral PI. METHODS: Patients undergoing AIB and PI between January 1990 and July 2002 were included in the study. They were classified into two groups on the basis of location of the proximal anastomosis. In group 1 the AIB proximal anastomosis was placed on the PI in the groin, whereas in group 2 the AIB proximal anastomosis was placed on a distal native groin artery. Patency, limb salvage, and patient survival in the two groups were calculated with the Kaplan-Meier method. The Cox proportional hazards model was used to determine independent risk factors affecting AIB patency. RESULTS: Two hundred twenty-nine patients underwent AIB and PI. In group 1, 23 AIBs became thrombosed concurrent with 26 PI occlusions, and in group 2, 7 AIBs became thrombosed concurrent with 36 PI occlusions (P <.001). Five-year assisted primary patency, limb salvage, and patient survival in groups 1 and 2 were 50% and 75% (P <.001, log-rank test), 78% and 90% (P =.005, log-rank test), and 56% and 69% (P = NS, log-rank test), respectively. Factors independently associated with AIB occlusion are hypertension (hazard ratio [HR], 3.41; 95% confidence interval [CI], 1.65-7.05; P =.001), postoperative warfarin sodium therapy (HR, 1.86; 95% CI, 1.07-3.23; P =.03), continued smoking (HR, 1.72; 95% CI, 0.93-3.18; P =.08), AIB arising from PI (HR, 2.38; 95% CI, 1.35-4.18; P =.003), and PI occlusion (HR, 3.70; 95% CI, 2.15-6.36; P <.001). CONCLUSION: A proximal AIB anastomosis located directly on the PI is an independent risk factor for decreased AIB patency of equal or greater importance than current smoking, hypertension, or PI occlusion. The proximal anastomosis of an AIB in a patient with an ipsilateral PI should be placed on a distal native artery. |
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Authors:
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Everett Y Lam; Gregory J Landry; James M Edwards; Richard A Yeager; Lloyd M Taylor; Gregory L Moneta |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter Volume: 39 ISSN: 0741-5214 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2004 Feb |
Date Detail:
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Created Date: 2004-01-26 Completed Date: 2004-02-19 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 336-42 Citation Subset: IM |
Affiliation:
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Division of Vascular Surgery, Oregon Health & Science University, Portland, OR 97239-3098, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anastomosis, Surgical Blood Vessel Prosthesis* Case-Control Studies Female Follow-Up Studies Graft Occlusion, Vascular / epidemiology* Humans Limb Salvage Male Proportional Hazards Models Retrospective Studies Risk Factors Saphenous Vein / transplantation Survival Analysis Survival Rate Thrombosis / epidemiology* Time Factors Vascular Patency |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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