title: Results of bypass graft surgery after prior angioplasty in critical limb ischaemia treatment.
abstract: The aim of this study was to determine the outcomes of primary bypass graft surgery (BGS) compared to BGS after failed angioplasty (PTA).
  
  
  
  Between January 2007 and January 2014, we performed 136 BGSs exclusively for the treatment of critical limb ischaemia. Two cohorts were identified: 1) primary BGS (n = 102; group I), and 2) BGS after prior PTA (n = 34; group II). Data were analysed retrospectively and the primary endpoints were the rates of secondary patency, amputation-free survival, freedom from major adverse outcomes (graft occlusion, amputation, or death), and overall survival, which were assessed with the Kaplan-Meier method.
  
  
  
  Both groups were comparable with a predominance of Rutherford's category 5 ischaemic lesions (73.3 %). Most patients had extensive TASC D athe-rosclerotic disease (83.6 %), and the main conduit was the greater saphenous vein (58.1 %). The mean follow-up time was 36.2 months. The 3-year secondary patency rates were better for group I (64.3 % vs 49.6 %; P = 0.04). During the same period, the amputation-free survival rates were similar between the groups (77.4 % vs 74.5 %; P = 0.59). For multivariate Cox regression analysis, BGS after prior PTA was the only factor associated with re-intervention for limb salvage (hazard ratio = 2.39; CI 95 % = 1.19 - 4.80; P = 0.02). At the 3-year point, there were no differences in the overall survival rates (72.6 % vs 70 %; P = 0.97), but the proportion of patients without adverse outcomes was higher in group I (37.3 % vs 13.4 %; P = 0.007).
  
  
  
  Although secondary patency was better after primary BGS, the amputation-free and overall survival rates support the use of BGS after prior PTA.
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo - HSPE, São Paulo, Brazil.
authors.forename: Marcus Vinícius Martins
authors.initials: MVM
authors.lastname: Cury
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo - HSPE, São Paulo, Brazil.
authors.forename: Francisco Cardoso
authors.initials: FC
authors.lastname: Brochado-Neto
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo - HSPE, São Paulo, Brazil.
authors.forename: Marcelo Fernando
authors.initials: MF
authors.lastname: Matielo
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo - HSPE, São Paulo, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: de Athayde Soares
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo - HSPE, São Paulo, Brazil.
authors.forename: Anna Karina Paiva
authors.initials: AK
authors.lastname: Sarpe
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo - HSPE, São Paulo, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Sacilotto
mesh_terms: D000368:Aged; D017130:Angioplasty; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*
keywords: Angioplasty failure; bypass graft surgery; critical limb ischaemia