Popliteal-to-Distal Bypass: Identifying Risk Factors Associated with Limb Loss and Graft Failure
Modern therapy, including endoluminal procedures and improved medical management, still yield less than desired results for tibial vessel occlusive disease. Despite the recent focus on these newer interventions, few modern series have evaluated the efficacy of popliteal-to-distal bypass procedures....
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| Veröffentlicht in: | Vascular and endovascular surgery 2005-09, Vol.39 (5), p.393-400 |
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| creator | Galaria, Irfan I. Surowiec, Scott M. Tanski, William J. Fegley, Allison J. Rhodes, Jeffrey M. Illig, Karl A. Shortell, Cynthia K. Green, Richard M. Davies, Mark G. |
| description | Modern therapy, including endoluminal procedures and improved medical management, still yield less than desired results for tibial vessel occlusive disease. Despite the recent focus on these newer interventions, few modern series have evaluated the efficacy of popliteal-to-distal bypass procedures. The authors aimed to determine the efficacy of popliteal-distal bypass and to identify adverse prognostic factors for ultimate limb salvage. Eighty-seven patients (54 men; average age: 63 years) underwent 92 popliteal-distal bypasses. Duplex ultrasound was utilized to assess patency of all grafts. Data were analyzed by life-table analysis to determine patency rates at postoperative intervals. Median patient follow-up was 2.4 years. Major indications for bypass included chronic limb ischemia (86%) and disabling claudication (8%); 62% of the limbs were considered threatened, and 74% of the proximal anastomoses were above-knee. All procedures were technically successful. There were no perioperative ( |
| doi_str_mv | 10.1177/153857440503900503 |
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Despite the recent focus on these newer interventions, few modern series have evaluated the efficacy of popliteal-to-distal bypass procedures. The authors aimed to determine the efficacy of popliteal-distal bypass and to identify adverse prognostic factors for ultimate limb salvage. Eighty-seven patients (54 men; average age: 63 years) underwent 92 popliteal-distal bypasses. Duplex ultrasound was utilized to assess patency of all grafts. Data were analyzed by life-table analysis to determine patency rates at postoperative intervals. Median patient follow-up was 2.4 years. Major indications for bypass included chronic limb ischemia (86%) and disabling claudication (8%); 62% of the limbs were considered threatened, and 74% of the proximal anastomoses were above-knee. All procedures were technically successful. There were no perioperative (<30 days) deaths, and 86% of patients were alive at 5 years. Cumulative patency rates were 74% at 6 months, 70% at 2 years, and 63% at 5 years. Limb salvage rates closely paralleled patency rates. At 5 years, 62% of the affected limbs were intact; 72% of the limbs lost were associated with early (<180 days) bypass failures. Predictors of limb loss included early graft failure (84 days vs 1,288 days, p <0.0001), younger age (57 years vs 64 years, p = 0.039), history of previous ipsilateral vascular procedures (50% vs 21%, p = 0.03), heavy (>1 ppd) tobacco use (p = 0.001), and a thrombosed femoral-popliteal bypass at presentation (p = 0.002). When successful, popliteal-distal bypass is associated with excellent long-term patency and limb salvage rates. Early failures are often associated with limb loss. Heavy tobacco use, younger age, early graft failures, repeat revascularization, and presentation with a thrombosed femoral-popliteal graft are associated with limb loss.</description><identifier>ISSN: 1538-5744</identifier><identifier>EISSN: 1938-9116</identifier><identifier>DOI: 10.1177/153857440503900503</identifier><identifier>PMID: 16193211</identifier><language>eng</language><publisher>708 Glen Cove Avenue, Glen Head, NY 11545, USA: SAGE Publications</publisher><subject>Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Arterial Occlusive Diseases - diagnostic imaging ; Arterial Occlusive Diseases - mortality ; Arterial Occlusive Diseases - surgery ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Vessel Prosthesis Implantation ; Cardiology. Vascular system ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Femoral Artery - surgery ; Follow-Up Studies ; Graft Occlusion, Vascular - diagnostic imaging ; Humans ; Intermittent Claudication - diagnostic imaging ; Intermittent Claudication - mortality ; Intermittent Claudication - surgery ; Ischemia - diagnostic imaging ; Ischemia - mortality ; Ischemia - surgery ; Life Tables ; Lower Extremity - blood supply ; Lower Extremity - diagnostic imaging ; Lower Extremity - physiopathology ; Male ; Medical sciences ; Middle Aged ; Neurology ; Popliteal Artery - diagnostic imaging ; Popliteal Artery - physiopathology ; Popliteal Artery - surgery ; Prosthesis Failure ; Retrospective Studies ; Risk Factors ; Salvage Therapy ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Survival Analysis ; Tibial Arteries - diagnostic imaging ; Tibial Arteries - physiopathology ; Tibial Arteries - surgery ; Ultrasonography, Doppler, Duplex ; Vascular diseases and vascular malformations of the nervous system ; Vascular Patency ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><ispartof>Vascular and endovascular surgery, 2005-09, Vol.39 (5), p.393-400</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c286t-cb3ee83aae12da741eeddd37ab9432abd4691310c472489f1835f00a937148a03</citedby><cites>FETCH-LOGICAL-c286t-cb3ee83aae12da741eeddd37ab9432abd4691310c472489f1835f00a937148a03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/153857440503900503$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/153857440503900503$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>309,310,314,780,784,789,790,21819,23930,23931,25140,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17179088$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16193211$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Galaria, Irfan I.</creatorcontrib><creatorcontrib>Surowiec, Scott M.</creatorcontrib><creatorcontrib>Tanski, William J.</creatorcontrib><creatorcontrib>Fegley, Allison J.</creatorcontrib><creatorcontrib>Rhodes, Jeffrey M.</creatorcontrib><creatorcontrib>Illig, Karl A.</creatorcontrib><creatorcontrib>Shortell, Cynthia K.</creatorcontrib><creatorcontrib>Green, Richard M.</creatorcontrib><creatorcontrib>Davies, Mark G.</creatorcontrib><title>Popliteal-to-Distal Bypass: Identifying Risk Factors Associated with Limb Loss and Graft Failure</title><title>Vascular and endovascular surgery</title><addtitle>Vasc Endovascular Surg</addtitle><description>Modern therapy, including endoluminal procedures and improved medical management, still yield less than desired results for tibial vessel occlusive disease. Despite the recent focus on these newer interventions, few modern series have evaluated the efficacy of popliteal-to-distal bypass procedures. The authors aimed to determine the efficacy of popliteal-distal bypass and to identify adverse prognostic factors for ultimate limb salvage. Eighty-seven patients (54 men; average age: 63 years) underwent 92 popliteal-distal bypasses. Duplex ultrasound was utilized to assess patency of all grafts. Data were analyzed by life-table analysis to determine patency rates at postoperative intervals. Median patient follow-up was 2.4 years. Major indications for bypass included chronic limb ischemia (86%) and disabling claudication (8%); 62% of the limbs were considered threatened, and 74% of the proximal anastomoses were above-knee. All procedures were technically successful. There were no perioperative (<30 days) deaths, and 86% of patients were alive at 5 years. Cumulative patency rates were 74% at 6 months, 70% at 2 years, and 63% at 5 years. Limb salvage rates closely paralleled patency rates. At 5 years, 62% of the affected limbs were intact; 72% of the limbs lost were associated with early (<180 days) bypass failures. Predictors of limb loss included early graft failure (84 days vs 1,288 days, p <0.0001), younger age (57 years vs 64 years, p = 0.039), history of previous ipsilateral vascular procedures (50% vs 21%, p = 0.03), heavy (>1 ppd) tobacco use (p = 0.001), and a thrombosed femoral-popliteal bypass at presentation (p = 0.002). When successful, popliteal-distal bypass is associated with excellent long-term patency and limb salvage rates. Early failures are often associated with limb loss. Heavy tobacco use, younger age, early graft failures, repeat revascularization, and presentation with a thrombosed femoral-popliteal graft are associated with limb loss.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arterial Occlusive Diseases - diagnostic imaging</subject><subject>Arterial Occlusive Diseases - mortality</subject><subject>Arterial Occlusive Diseases - surgery</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Vessel Prosthesis Implantation</subject><subject>Cardiology. Vascular system</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Femoral Artery - surgery</subject><subject>Follow-Up Studies</subject><subject>Graft Occlusion, Vascular - diagnostic imaging</subject><subject>Humans</subject><subject>Intermittent Claudication - diagnostic imaging</subject><subject>Intermittent Claudication - mortality</subject><subject>Intermittent Claudication - surgery</subject><subject>Ischemia - diagnostic imaging</subject><subject>Ischemia - mortality</subject><subject>Ischemia - surgery</subject><subject>Life Tables</subject><subject>Lower Extremity - blood supply</subject><subject>Lower Extremity - diagnostic imaging</subject><subject>Lower Extremity - physiopathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Popliteal Artery - diagnostic imaging</subject><subject>Popliteal Artery - physiopathology</subject><subject>Popliteal Artery - surgery</subject><subject>Prosthesis Failure</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Salvage Therapy</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Survival Analysis</subject><subject>Tibial Arteries - diagnostic imaging</subject><subject>Tibial Arteries - physiopathology</subject><subject>Tibial Arteries - surgery</subject><subject>Ultrasonography, Doppler, Duplex</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><subject>Vascular Patency</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><issn>1538-5744</issn><issn>1938-9116</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90MFO3DAQBmCrAnWB9gV6QL7ALeCJvbHTG4VCkVYCofacTmxnMc0mW48jtG9fr3YlDpW4eHz4Zsb-GfsC4gJA60uYSzPXSom5kLXYnh_YEdTSFDVAdZDvGRRbMWPHRC9CgAFlPrIZVJmVAEfs9-O47kPy2BdpLG4CJez5t80aib7ye-eHFLpNGJb8KdAffos2jZH4FdFoAybv-GtIz3wRVi1fjEQcB8fvInYp29BP0X9ihx325D_v6wn7dfv95_WPYvFwd399tShsaapU2FZ6bySih9KhVuC9c05qbGslS2ydqmqQIKzSpTJ1B0bOOyGwljp_CYU8Yee7ues4_p08pWYVyPq-x8GPEzWVqZQwUmZY7qCN-cHRd806hhXGTQOi2eba_J9rbjrdT5_alXdvLfsgMzjbAySLfRdxsIHenAZdC2Oyu9w5wqVvXsYpDjmV91b_A4y5jH0</recordid><startdate>200509</startdate><enddate>200509</enddate><creator>Galaria, Irfan I.</creator><creator>Surowiec, Scott M.</creator><creator>Tanski, William J.</creator><creator>Fegley, Allison J.</creator><creator>Rhodes, Jeffrey M.</creator><creator>Illig, Karl A.</creator><creator>Shortell, Cynthia K.</creator><creator>Green, Richard M.</creator><creator>Davies, Mark G.</creator><general>SAGE Publications</general><general>Westminster</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200509</creationdate><title>Popliteal-to-Distal Bypass: Identifying Risk Factors Associated with Limb Loss and Graft Failure</title><author>Galaria, Irfan I. ; Surowiec, Scott M. ; Tanski, William J. ; Fegley, Allison J. ; Rhodes, Jeffrey M. ; Illig, Karl A. ; Shortell, Cynthia K. ; Green, Richard M. ; Davies, Mark G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c286t-cb3ee83aae12da741eeddd37ab9432abd4691310c472489f1835f00a937148a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arterial Occlusive Diseases - diagnostic imaging</topic><topic>Arterial Occlusive Diseases - mortality</topic><topic>Arterial Occlusive Diseases - surgery</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Vessel Prosthesis Implantation</topic><topic>Cardiology. Vascular system</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Female</topic><topic>Femoral Artery - surgery</topic><topic>Follow-Up Studies</topic><topic>Graft Occlusion, Vascular - diagnostic imaging</topic><topic>Humans</topic><topic>Intermittent Claudication - diagnostic imaging</topic><topic>Intermittent Claudication - mortality</topic><topic>Intermittent Claudication - surgery</topic><topic>Ischemia - diagnostic imaging</topic><topic>Ischemia - mortality</topic><topic>Ischemia - surgery</topic><topic>Life Tables</topic><topic>Lower Extremity - blood supply</topic><topic>Lower Extremity - diagnostic imaging</topic><topic>Lower Extremity - physiopathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Popliteal Artery - diagnostic imaging</topic><topic>Popliteal Artery - physiopathology</topic><topic>Popliteal Artery - surgery</topic><topic>Prosthesis Failure</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Salvage Therapy</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Survival Analysis</topic><topic>Tibial Arteries - diagnostic imaging</topic><topic>Tibial Arteries - physiopathology</topic><topic>Tibial Arteries - surgery</topic><topic>Ultrasonography, Doppler, Duplex</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><topic>Vascular Patency</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Galaria, Irfan I.</creatorcontrib><creatorcontrib>Surowiec, Scott M.</creatorcontrib><creatorcontrib>Tanski, William J.</creatorcontrib><creatorcontrib>Fegley, Allison J.</creatorcontrib><creatorcontrib>Rhodes, Jeffrey M.</creatorcontrib><creatorcontrib>Illig, Karl A.</creatorcontrib><creatorcontrib>Shortell, Cynthia K.</creatorcontrib><creatorcontrib>Green, Richard M.</creatorcontrib><creatorcontrib>Davies, Mark G.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Vascular and endovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Galaria, Irfan I.</au><au>Surowiec, Scott M.</au><au>Tanski, William J.</au><au>Fegley, Allison J.</au><au>Rhodes, Jeffrey M.</au><au>Illig, Karl A.</au><au>Shortell, Cynthia K.</au><au>Green, Richard M.</au><au>Davies, Mark G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Popliteal-to-Distal Bypass: Identifying Risk Factors Associated with Limb Loss and Graft Failure</atitle><jtitle>Vascular and endovascular surgery</jtitle><addtitle>Vasc Endovascular Surg</addtitle><date>2005-09</date><risdate>2005</risdate><volume>39</volume><issue>5</issue><spage>393</spage><epage>400</epage><pages>393-400</pages><issn>1538-5744</issn><eissn>1938-9116</eissn><abstract>Modern therapy, including endoluminal procedures and improved medical management, still yield less than desired results for tibial vessel occlusive disease. Despite the recent focus on these newer interventions, few modern series have evaluated the efficacy of popliteal-to-distal bypass procedures. The authors aimed to determine the efficacy of popliteal-distal bypass and to identify adverse prognostic factors for ultimate limb salvage. Eighty-seven patients (54 men; average age: 63 years) underwent 92 popliteal-distal bypasses. Duplex ultrasound was utilized to assess patency of all grafts. Data were analyzed by life-table analysis to determine patency rates at postoperative intervals. Median patient follow-up was 2.4 years. Major indications for bypass included chronic limb ischemia (86%) and disabling claudication (8%); 62% of the limbs were considered threatened, and 74% of the proximal anastomoses were above-knee. All procedures were technically successful. There were no perioperative (<30 days) deaths, and 86% of patients were alive at 5 years. Cumulative patency rates were 74% at 6 months, 70% at 2 years, and 63% at 5 years. Limb salvage rates closely paralleled patency rates. At 5 years, 62% of the affected limbs were intact; 72% of the limbs lost were associated with early (<180 days) bypass failures. Predictors of limb loss included early graft failure (84 days vs 1,288 days, p <0.0001), younger age (57 years vs 64 years, p = 0.039), history of previous ipsilateral vascular procedures (50% vs 21%, p = 0.03), heavy (>1 ppd) tobacco use (p = 0.001), and a thrombosed femoral-popliteal bypass at presentation (p = 0.002). When successful, popliteal-distal bypass is associated with excellent long-term patency and limb salvage rates. Early failures are often associated with limb loss. Heavy tobacco use, younger age, early graft failures, repeat revascularization, and presentation with a thrombosed femoral-popliteal graft are associated with limb loss.</abstract><cop>708 Glen Cove Avenue, Glen Head, NY 11545, USA</cop><pub>SAGE Publications</pub><pmid>16193211</pmid><doi>10.1177/153857440503900503</doi><tpages>8</tpages></addata></record> |
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| ispartof | Vascular and endovascular surgery, 2005-09, Vol.39 (5), p.393-400 |
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| subjects | Adolescent Adult Age Factors Aged Aged, 80 and over Arterial Occlusive Diseases - diagnostic imaging Arterial Occlusive Diseases - mortality Arterial Occlusive Diseases - surgery Biological and medical sciences Blood and lymphatic vessels Blood Vessel Prosthesis Implantation Cardiology. Vascular system Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Femoral Artery - surgery Follow-Up Studies Graft Occlusion, Vascular - diagnostic imaging Humans Intermittent Claudication - diagnostic imaging Intermittent Claudication - mortality Intermittent Claudication - surgery Ischemia - diagnostic imaging Ischemia - mortality Ischemia - surgery Life Tables Lower Extremity - blood supply Lower Extremity - diagnostic imaging Lower Extremity - physiopathology Male Medical sciences Middle Aged Neurology Popliteal Artery - diagnostic imaging Popliteal Artery - physiopathology Popliteal Artery - surgery Prosthesis Failure Retrospective Studies Risk Factors Salvage Therapy Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Survival Analysis Tibial Arteries - diagnostic imaging Tibial Arteries - physiopathology Tibial Arteries - surgery Ultrasonography, Doppler, Duplex Vascular diseases and vascular malformations of the nervous system Vascular Patency Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels |
| title | Popliteal-to-Distal Bypass: Identifying Risk Factors Associated with Limb Loss and Graft Failure |
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