title: Long-term outcome after early infrainguinal graft failure.
abstract: OBJECTIVE
  To determine the long-term outcome and prognostic factors after early infrainguinal graft failure (< 30 days).
  
  
  METHODS
  Retrospective analysis of limb salvage data, patency data, and prognostic risk factors in 112 new infrainguinal bypass grafts from 1985 to 1995 that occluded within 30 days of operation.
  
  
  RESULTS
  Thirty-six femoropopliteal and 76 femorotibial/femoropedal arterial bypass ("index") procedures were performed for rest pain (50%), tissue loss (31%), or disabling claudication (19%). In 103 patients, an immediate additional revascularization ("takeback") procedure was performed at the time of early graft failure. Life table analysis of the takeback procedures for threatened limbs (n = 84) revealed limb salvage rates of 74%, 54%, 40%, and 31% at 1 month, 1 year, 3 years, and 5 years, respectively. The 1-month limb salvage rate (threatened limbs) was 12% (1 of 8) in patients who were not taken back for revascularization and 33% (4 of 12) in patients who had undergone more than one takeback procedure within 30 days. The secondary graft patency rates for the takeback procedures (n = 103) were 70%, 37%, 27%, and 23% at 1 month, 1 year, 3 years, and 5 years, respectively. Univariate and life table analysis revealed that patients who were given anticoagulation medication after the index procedure (before graft thrombosis) or patients who had undergone previous ipsilateral leg revascularization had significantly lower rates of limb salvage and graft patency (p < 0.05). The limb salvage rate was also significantly worse in patients who had single-vessel runoff compared with those who had multiple-vessel runoff (p < 0.01). Thrombectomy and revision or complete graft replacement had a better secondary patency rate than thrombectomy alone (p < 0.05). Autogenous vein grafts had better outcome than polytetrafluoroethylene-containing grafts, but statistical significance was not achieved. No significant differences in limb salvage or graft patency rates were found between femoropopliteal versus femorotibial/femoropedal bypass grafting, age, gender, previous inflow surgery, diabetes, hypertension, smoking, or cardiac, renal, or pulmonary disease.
  
  
  CONCLUSIONS
  The long-term limb salvage and graft patency rates after takeback revascularization procedures for early graft failure are poor. Despite poor outcome, a single takeback procedure appears warranted in all patients. Multiple takeback procedures, however, do not appear to be justified, especially in patients who are given anticoagulation medication after the index bypass procedure, repeat leg bypass procedures, or if there is no potential for graft revision.
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Robinson
authors.forename: D T
authors.initials: DT
authors.lastname: Sato
authors.forename: R T
authors.initials: RT
authors.lastname: Gregory
authors.forename: R G
authors.initials: RG
authors.lastname: Gayle
authors.forename: R J
authors.initials: RJ
authors.lastname: DeMasi
authors.forename: F N
authors.initials: FN
authors.lastname: Parent
authors.forename: J R
authors.initials: JR
authors.lastname: Wheeler
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome