Infrainguinal reconstructions: influence of surgical experience on outcome.
OBJECTIVE
To evaluate the influence of surgical experience and operation technique on the outcome of infrainguinal reconstructions.


METHODS
A longitudinal observational study of patients undergoing reconstructions to the popliteal and crural arteries.


METHODS
A regional hospital and an academic referral centre.


METHODS
392 patients undergoing 442 reconstructions, 218 to the popliteal and 228 to the crural vessels.


METHODS
Graft patency and leg salvage.


RESULTS
At the popliteal level, 5-year patency after autogenous vein reconstruction was 76%. No difference was found between in situ and transposed vein reconstructions, but prosthetic reconstructions had a worse patency. At the crural level, 5-year patency for in situ vein, transposed vein and prosthetic bypass were 66, 55 and 21%, respectively. Corresponding leg salvage for chronic critical leg ischaemia was 91% with vein and 55% with prosthetic reconstruction at popliteal level, and 66 and 33% at the crural level. Surgical experience improved the outcome, as 3-year patency for in situ and transposed vein bypasses to the popliteal level were 82 and 95% for experienced surgeons, and 53 and 75% for less experienced surgeons. Corresponding leg salvage rates for reconstructions to the popliteal and crural levels were 85 and 67% for experienced surgeons, and 61 and 52% for less experienced surgeons.


CONCLUSIONS
Outcome of infrainguinal reconstructions is influenced by the reconstruction level. Surgical experience and choice of the appropriate reconstruction technique can improve outcome.
Luther
M
M
Vasa Central Hospital, Surgical Department, Finland.
Lepäntalo
M
M
D000368:Aged; D000714:Anastomosis, Surgical; D019917:Blood Vessel Prosthesis Implantation; D002983:Clinical Competence; D003925:Diabetic Angiopathies / Q000601:surgery; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008137:Longitudinal Studies; D008297:Male; D011150:Popliteal Artery / Q000601:surgery*; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*