title: Patency and limb salvage after infrainguinal bypass with severely compromised ("blind") outflow.
abstract: OBJECTIVE
  Infrainguinal graft patency and limb salvage are adversely affected by severely compromised outflow.
  
  
  METHODS
  Retrospective review of all infrainguinal bypass procedures performed at a single institution during a 5-year period.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Two hundred seventy-four patients underwent infrainguinal bypass for limb salvage (351 grafts in 307 limbs).
  
  
  METHODS
  All infrainguinal bypasses originated from a femoral artery. The distal anastomosis in 279 grafts was located in an artery with at least 1 patent outflow vessel with anatomically normal end-artery runoff (Society for Vascular Surgery/International Society for Cardiovascular Surgery ad hoc committee runoff score, 1-9). The distal anastomosis of 72 grafts was located in an artery with only collateral outflow ("blind bypass"; runoff score, 10).
  
  
  METHODS
  Perioperative morbidity and mortality, primary-assisted and secondary graft patency, limb salvage, and survival.
  
  
  RESULTS
  All data are presented as mean +/- SEM. Patients undergoing blind bypass were older (age, 70 +/- 2 vs. 66 +/- 1 years; P <.05) and had a higher incidence of hypertension (90% vs 70%; P <.05) and end-stage renal disease (24% vs. 13%; P <.05). Comparing patients undergoing blind bypass to bypass with at least 1 patent outflow vessel, there were no differences in the use of nonautogenous conduits (50% vs 59%; P =.21) or postoperative warfarin (30% vs 32%; P =.69), or in perioperative mortality rates (2.7% vs 3.2%; P =.79). After a median follow-up of 13 months (range, 0-60 months), 2-year secondary graft patency for the entire group was 63% +/- 4%. The secondary patency rate of blind bypass grafts was no different from that of grafts with at least 1 patent outflow vessel (67% +/- 7% vs. 64% +/- 4%; P was not significant). However, the 2-year limb salvage rate in limbs with blind outflow was significantly worse than in limbs with at least 1 patent outflow vessel (67% +/- 7% vs. 76% +/- 3%; P =.04).
  
  
  CONCLUSIONS
  Acceptable long-term patency rates can be achieved in infrainguinal bypass grafts with blind outflow, although blind outflow remains a marker for subsequent limb loss in the chronically ischemic leg.
authors.affiliation: University of Chicago, MC 5028, 5841 S Maryland Ave, Chicago, IL 60637, USA. tdesai@surgery.bsd.uchicago.edu
authors.forename: T R
authors.initials: TR
authors.lastname: Desai
authors.forename: S L
authors.initials: SL
authors.lastname: Meyerson
authors.forename: C L
authors.initials: CL
authors.lastname: Skelly
authors.forename: K S
authors.initials: KS
authors.lastname: MacKenzie
authors.forename: H S
authors.initials: HS
authors.lastname: Bassiouny
authors.forename: D
authors.initials: D
authors.lastname: Katz
authors.forename: J F
authors.initials: JF
authors.lastname: McKinsey
authors.forename: B L
authors.initials: BL
authors.lastname: Gewertz
authors.forename: L B
authors.initials: LB
authors.lastname: Schwartz
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001161:Arteriosclerosis / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D012501:Saphenous Vein / Q000637:transplantation*; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency