title: A 10-year experience with complementary distal arteriovenous fistula and deep vein interposition for infrapopliteal prosthetic bypasses.
abstract: Since up to 20% of patients undergoing lower extremity revascularization do not have an adequate venous conduit, some authors have explored the use of prosthetic grafts with adjunctive techniques for lower extremity revascularization. However, the long-term graft patency of those procedures has not been well documented. The purpose of this study was to examine the long-term patency of polytetrafluoroethylene (PTFE) bypass with adjunctive arteriovenous fistula and venous interposition (AVF/VI) for infrapopliteal revascularization. Over a 10-year period, 246 lower extremity reconstructions were performed in 176 (71.5% men) patients with critical ischemia in whom a totally autogenous vein bypass was not feasible. Seventy-six limbs had undergone 1 or more failed ipsilateral infrainguinal bypasses. Indications for surgery were chronic critical limb-threatening ischemia (86%) (rest pain, ischemic ulcer, or gangrene) or acute ischemia (14%). Ages ranged from 46 to 91 years (mean 74 +/-0.6 [SD] years). Risk factors such as diabetes, hypertension, coronary artery disease, end-stage renal disease, and use of tobacco were present in 49%, 49%, 52%, 8%, and 67% of the patients, respectively. During the follow-up, 112 cases (45%) required reinterventions. Twenty-seven patients (15%) required bypass revision twice. During the follow up, 56 limbs (23%) were amputated (above-the-knee amputation 25 (10%); below-the-knee amputation 31 (13%). To date, 150 (85%) patients of a total of 176 are deceased. The primary graft patency rates were as follows: at 1 year, 51%; at 2 years, 41%; 3 years, 35%; and 5 years, 24%. Limb salvage rates were as follows: 1 year, 79%; 2 years, 76%; 3 years 76%; and 5 years, 74%. Patient survival rates were as follows: 1 year, 69%; 2 years, 60%; 3 years, 54%; and 5 years, 40%. Amputation-free patient survival rates were as follows: 1 year, 66%; 2 years, 57%, 3 years, 51%, and 5 years, 30%. This technique appears to offer reasonable patency and limb salvage rates in patients in whom autogenous bypass grafts are not feasible.
authors.affiliation: Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA.
authors.forename: Anil P
authors.initials: AP
authors.lastname: Hingorani
authors.forename: Enrico
authors.initials: E
authors.lastname: Ascher
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Marks
authors.forename: Richard W
authors.initials: RW
authors.lastname: Schutzer
authors.forename: Manikyam
authors.initials: M
authors.lastname: Mutyala
authors.forename: Suresh
authors.initials: S
authors.lastname: Nahata
authors.forename: William
authors.initials: W
authors.lastname: Yorkovich
authors.forename: Audrey
authors.initials: A
authors.lastname: Kucherina
authors.forename: Theresa
authors.initials: T
authors.lastname: Jacob
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D005260:Female; D005263:Femoral Artery / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009518:New York; D011138:Polytetrafluoroethylene; D011150:Popliteal Artery / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D011152:Popliteal Vein / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D016909:Tibial Arteries / Q000601:surgery; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene