title: Limb salvage after infrainguinal bypass graft failure.
abstract: OBJECTIVE
  The purpose of this study was to examine the outcome of patients in whom an infrainguinal bypass graft failed.
  
  
  METHODS
  This was a retrospective analysis of consecutive patients undergoing infrainguinal bypass grafting in a single institution over 8 years.
  
  
  RESULTS
  Six hundred thirty-one infrainguinal bypass grafts were placed in 578 limbs in 503 patients during the study period. The indication for surgery was limb-threatening ischemia in 533 patients (85%); nonautologous conduits were used in 259 patients (41%), and 144 (23%) were repeat operations. After a mean follow-up of 28 +/- 1 months (median, 23 months; range, 0-99 months), 167 grafts (26%) had failed secondarily. The rate of limb salvage in patients with graft failure was poor, only 50% +/- 5% at 2 years after failure. The 2-year limb salvage rate depended on the initial indication for bypass grafting: 100% in patients with claudication (n = 16), 55% +/- 8% in patients with rest pain (n = 49), and 34% +/- 6% in patients with tissue loss (n = 73; P <.001). The prospect for limb salvage also depended on the duration that the graft remained patent. Early graft failure (<30 days; n = 25) carried a poor prognosis, with 2-year limb salvage of only 25% +/- 10%; limb salvage was 53% +/- 5% after intermediate graft failure (<2 years, n = 110) and 79% +/- 10% after late failure (>2 years, n = 15; P =.04). Multivariate analysis revealed shorter patency interval before failure (P =.006), use of warfarin sodium (Coumadin) postoperatively (P =.006), and infrapopliteal distal anastomosis (P =.01) as significant predictors for ultimate limb loss.
  
  
  CONCLUSIONS
  The overall prognosis for limb salvage in patients with failed infrainguinal bypass grafts is poor, particularly in patients with grafts placed because of tissue loss and those with early graft failure.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Chicago, Chicago, Ill, USA.
authors.forename: Zachary K
authors.initials: ZK
authors.lastname: Baldwin
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Pearce
authors.forename: Michael A
authors.initials: MA
authors.lastname: Curi
authors.forename: Tina R
authors.initials: TR
authors.lastname: Desai
authors.forename: James F
authors.initials: JF
authors.lastname: McKinsey
authors.forename: Hisham S
authors.initials: HS
authors.lastname: Bassiouny
authors.forename: Daniel
authors.initials: D
authors.lastname: Katz
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Gewertz
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Schwartz
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014654:Vascular Patency; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D014859:Warfarin