title: Contemporary Outcomes for Open Infrainguinal Bypass in the Endovascular Era.
abstract: BACKGROUND
  The role of infrainguinal bypasses in this era of increasing endovascular interventions remains the subject of significant debate. In this study, we evaluate contemporary long-term outcomes of lower-extremity open revascularization for peripheral arterial disease (PAD).
  
  
  METHODS
  We evaluated all patients who underwent infrainguinal bypass with autogenous vein conduits for claudication or critical limb ischemia in our institution between January 1st, 2007 and July 31st, 2014. Kaplan-Meier and Cox regression analyses were used to evaluate graft failure and identify its predictors. Outcomes were defined per the Society for Vascular Surgery standards.
  
  
  RESULTS
  There were 428 autogenous vein grafts (femoro-popliteal: 32%, femoro-tibial: 39%, popliteo-tibial: 27%, and tibio-tibial: 2%) placed in 368 patients (mean age of 67 ± 11.4 years). Most patients were male (59%), white (73%), and presented with critical limb ischemia (81%). Sixty-five cases (15%) were redo bypasses. Arm veins and spliced vein conduits were used in 15% and 14% of cases, respectively. Primary patency at 1, 3, and 5 years was 66%, 59%, and 55%, respectively. Primary-assisted patency was 78%, 69%, and 64% at 1, 3, and 5 years, respectively. Secondary patency was 88%, 84%, and 82% at 1, 3, and 5 years, respectively. Patency was higher for grafts harvested from the lower versus upper extremities and for proximal versus distal bypass (all P < 0.05). Limb salvage rate was 88% after a mean follow-up of 2 ± 1.8 years. Significant predictors of graft failure were younger age, diabetes mellitus, and hyperlipidemia (all P < 0.05).
  
  
  CONCLUSIONS
  In this contemporary cohort of patients, we have demonstrated that infrainguinal bypass for lower-extremity revascularization has good long-term outcomes in patients with symptomatic PAD. Patency and limb salvage rates are optimized with careful selection of autogenous conduits, close monitoring of high-risk groups and management of comorbidities.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Johns Hopkins Medical Institution, Baltimore, MD.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reifsnyder
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Johns Hopkins Medical Institution, Baltimore, MD.
authors.forename: Isibor J
authors.initials: IJ
authors.lastname: Arhuidese
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Johns Hopkins Medical Institution, Baltimore, MD.
authors.forename: Caitlin W
authors.initials: CW
authors.lastname: Hicks
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Johns Hopkins Medical Institution, Baltimore, MD.
authors.forename: Tammam
authors.initials: T
authors.lastname: Obeid
authors.affiliation: Department of Surgery, Frank H. Netter School of Medicine, Quinnipiac University, Hamden, CT.
authors.forename: Karen E M
authors.initials: KE
authors.lastname: Massada
authors.affiliation: Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Khaled
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Johns Hopkins Medical Institution, Baltimore, MD.
authors.forename: Umair
authors.initials: U
authors.lastname: Qazi
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Johns Hopkins Medical Institution, Baltimore, MD. Electronic address: mbmalas@jhmi.edu.
authors.forename: Mahmoud B
authors.initials: MB
authors.lastname: Malas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting; D014654:Vascular Patency