Single-center experience in endovascular treatment for infrainguinal bypass obstructions

Abstract

Purpose: To evaluate patency and clinical efficacy of endovascular therapy for infrainguinal bypass obstructions.

Materials and methods: Patients were categorized with regard to symptoms (asymptomatic/intermittent claudication [IC] vs critical limb ischemia [CLI]), bypass graft material used (autologous vs prosthetic graft), and localization of distal anastomoses (femoropopliteal vs femorodistal bypass). Primary patency was defined as absence of sonographically verified stenosis greater than 50%. Assisted primary patency was applied to secondary revisions to prevent impending occlusion. Secondary patency refers to repeat interventions aimed at restoring bypass patency after occlusion. Primary sustained clinical improvement in IC was defined as an upward shift of at least one category per Rutherford classification, accordingly to a level of claudication in patients with CLI.

Results: A total of 54 patients (54 limbs, 12 with CLI) were included. At 1 year, primary patency rates were 74% in IC and 27% in CLI (P = .001), primary assisted patency rates were 85% in IC and 68% in CLI (P = .05), and secondary patency rates were 89% in IC and 100% in CLI (P = .32). Accordingly, primary sustained clinical improvement rates were 64% in IC and 25% in CLI (P = .018). After adjustment for confounding factors, CLI (hazard ratio [HR], 7.8; 95% CI, 2.3-26.32; P = .001) and impaired patent runoff (ie, less than three crural runoff vessels; HR, 0.16; 95% CI, 0.03-0.96; P = .045) were independently associated with impaired primary patency.

Conclusions: Endovascular revascularization is a reasonable treatment option to prevent impending bypass occlusion. Presence of CLI and impaired crural runoff are independent risk factors for lower patency rates.