title: Morbidity of femoropopliteal bypass surgery.
abstract: A systemic review of published reports on the incidence of early (<30 days) adverse events occurring after above- or below-knee femoropopliteal bypass surgery was conducted to provide contemporary outcomes data for comparative reporting. A total of 38 articles were included describing 6,374 femoropopliteal bypasses in 6,007 patients. Fifty-two percent were male and the mean age was 64.6 years (range, 40 to 93 years). The various studied types of complications were reported in 10 to 34 of 38 articles and definitions were often missing. The overall 30-day morbidity rate was 36.8%. The wound infection rate was 7.8% (range, 0.0 to 17.4%) accompanied with dermal necrosis in 0.4%. Graft infection was described in 2.4% (range, 0.0 to 5.3%) of cases. Postoperative bleeding was seen in 7.4% (range, 0.0 to 26%), of which 2.5% required return to surgery. Occlusions were reported in 12.0% (range, 0.0 to 59%). Lymphedema occurred in 2.9% (range, 0.0 to 9.6%) of cases and surgical site seroma formation occurred in 2.0% (range, 1.0% to 3.0%). Overall 30-day mortality rate was 2.3% (range 0.0 to 4.3%). Pooled data comparing vein grafts and prosthetic grafts revealed no significant difference (P = .10; risk ratio = 0.82; 95% confidence interval, 0.66-1.03; I(2) = 0%) in the incidence of complications. This review confirmed the morbidity of femoropopliteal bypass surgery is inconsistently reported and definitions are lacking. Because one-third of patients can be expected to experience an adverse event after femoropopliteal bypass grafting, standards on defining and reporting complications are necessary if comparative outcome standards are developed.
authors.affiliation: Department of Surgery, Rijnstate Hospital, Wagnerlaan 55, 6816 AD, Arnhem, The Netherlands.
authors.forename: Maarten A J
authors.initials: MA
authors.lastname: van de Weijer
authors.affiliation: Department of Surgery, Isala Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: Rombout R
authors.initials: RR
authors.lastname: Kruse
authors.affiliation: Department of Surgery, Rijnstate Hospital, Wagnerlaan 55, 6816 AD, Arnhem, The Netherlands.
authors.forename: Katja
authors.initials: K
authors.lastname: Schamp
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RG, Groningen, The Netherlands.
authors.forename: Clark J
authors.initials: CJ
authors.lastname: Zeebregts
authors.affiliation: Department of Surgery, Rijnstate Hospital, Wagnerlaan 55, 6816 AD, Arnhem, The Netherlands. Electronic address: mmpj.reijnen@gmail.com.
authors.forename: Michel M P J
authors.initials: MM
authors.lastname: Reijnen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011150:Popliteal Artery / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D019984:Quality Indicators, Health Care; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000592:standards