title: Outcomes after open infrainguinal bypass in patients with scleroderma.
abstract: There are limited reports of outcomes after infrainguinal bypass surgery in patients with scleroderma. This study evaluated the long-term outcome after lower extremity bypass in these patients.
  
  
  
  The study included all patients with systemic sclerosis who underwent infrainguinal bypass surgery for severe peripheral arterial disease at our institution from January 1, 2007, to August 31, 2014. Kaplan-Meier and Cox regression analyses were used to evaluate graft failure and limb salvage. These outcomes were compared with those of nonscleroderma patients who underwent infrainguinal bypass surgery during the same period. Outcomes were defined and evaluated by Society for Vascular Surgery standards.
  
  
  
  There were 18 autogenous grafts (6% femoral-popliteal, 11% femoral-tibial, 72% popliteal-tibial, 11% tibial-tibial) placed in 18 limbs from 12 patients with systemic sclerosis. Mean ± standard deviation age was 71 ± 9.5 years, and most of the patients were women (83%) and white (78%). All patients presented with critical limb ischemia. History of hypertension and coronary artery disease were 94% and 61%, respectively. All grafts used were autogenous, continuous, and harvested from the lower extremity (nonreversed great saphenous in 61% and reversed great saphenous in 39%). Mean follow-up duration was 2.3 ± 1.6 years. Graft failure was significantly higher in scleroderma patients than in nonscleroderma patients who underwent bypass in the same study period (hazard ratio, 7.2; 95% confidence interval, 1.44-41.4; P = .02). The limb salvage rate was 72%.
  
  
  
  Long-term outcomes after open infrainguinal bypass surgery in scleroderma patients are significantly worse than those in nonscleroderma patients. Careful consideration of their inherently poor outcomes should be made when reaching a decision for revascularization.
authors.affiliation: Division of Vascular Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Md.
authors.forename: Isibor
authors.initials: I
authors.lastname: Arhuidese
authors.affiliation: Division of Vascular Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Md. Electronic address: bmalas1@jhmi.edu.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Malas
authors.affiliation: Division of Vascular Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Md.
authors.forename: Tammam
authors.initials: T
authors.lastname: Obeid
authors.affiliation: Frank H. Netter School of Medicine, Quinnipiac University, Hamden, Conn.
authors.forename: Karen
authors.initials: K
authors.lastname: Massada
authors.affiliation: Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Khaled
authors.affiliation: Division of Vascular Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Md.
authors.forename: Anas
authors.initials: A
authors.lastname: Alzahrani
authors.affiliation: Division of Vascular Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Md.
authors.forename: Georges
authors.initials: G
authors.lastname: Samaha
authors.affiliation: Division of Vascular Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Md.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reifsnyder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064592:Autografts; D015142:Baltimore; D016638:Critical Illness; D005260:Female; D006085:Graft Survival; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods*; D014654:Vascular Patency