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Clinical Research|Articles in Press

Impact of Revascularization Technique on the Outcomes of Peripheral Graft Revision Procedures

Published:February 28, 2023DOI:https://doi.org/10.1016/j.avsg.2023.02.019
Impact of Revascularization Technique on the Outcomes of Peripheral Graft Revision Procedures
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      Background

      The acute occlusion of a peripheral bypass graft leads to acute limb ischemia (ALI) and threatens the viability of the limb if left untreated. The aim of the present study was to analyze the results of surgical and hybrid revascularization techniques for patients with ALI due to peripheral graft occlusions.

      Methods

      A retrospective analysis of 102 patients undergoing treatment for ALI due to peripheral graft occlusion between 2002 and 2021 was carried out at a tertiary vascular center. Procedures were classified as surgical when only surgical techniques were used and as hybrid when surgical procedures were combined with endovascular techniques such as balloon or stent angioplasty or thrombolysis. Endpoints were primary and secondary patency and amputation-free survival after 1 and 3 years.

      Results

      Of all patients, 67 met the inclusion criteria, 41 were treated surgically and 26 by hybrid procedures. There were no significant differences in the 30-day patency rate, 30-day amputation rate, and 30-day mortality. The 1- and 3-year primary patency rates were 41.4% and 29.2% overall, respectively; 45% and 32.1% in the surgical group, respectively; and 33.2% and 26.6% in the hybrid group, respectively. The 1- and 3-year secondary patency rates were 54.1% and 35.8% overall, respectively; 52.5% and 34.2% in the surgical group, respectively; and 54.4% and 43.5% in the hybrid group, respectively. The 1- and 3-year amputation-free survival rates were 67.5% and 59.2%, overall, respectively; 67.3% and 67.3% in the surgical group, respectively; and 68.5% and 48.2% in the hybrid group, respectively. There were no significant differences between the surgical and the hybrid groups.

      Conclusions

      The results of surgical and hybrid procedures after bypass thrombectomy for ALI to eliminate the cause of infrainguinal bypass occlusion are comparable with good midterm results in terms of amputation-free survival. New endovascular techniques and devices need to be established in comparison to the results of these proven surgical revascularization methods.

      Graphical abstract

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      Graphical Abstract
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      Article info

      Publication history

      Published online: February 28, 2023
      Accepted: February 14, 2023
      Received: December 1, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Conflicts of interest: The authors declare no conflicts of interest.

      Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      Author Contributions: Conceptualization, T.B., K.P., and L.K.; methodology, T.B.; software, L.K.; validation, T.B., L.K., and K.P.; formal analysis, L.K.; investigation, L.K.; resources, L.K.; data curation, L.K.; writing—original draft preparation, L.K. and T.B.; writing—review and editing, L.K., T.B., K.P. W.S., and G.S; visualization, L.K.; supervision, T.B. and K.P.; project administration, T.B. All authors have read and agreed to the published version of the manuscript.

      Institutional Review Board Statement: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board—University Medical Center Regensburg, approval number 14-17-10, date of approval: January 14, 2014.

      Informed Consent Statement: Patient consent to be included in the PAD registry and for the future analysis of their data was obtained at admission to the hospital.

      Data Availability Statement: The data presented in this study are available upon request from the corresponding author.

      Identification

      DOI: https://doi.org/10.1016/j.avsg.2023.02.019

      Copyright

      © 2023 Elsevier Inc. All rights reserved.

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