Abstract from the 2015 New England Society for Vascular Surgery Annual MeetingAlternative Conduit for Infrageniculate Bypass in Patients With Critical Limb Ischemia

We sought to compare outcomes of different conduit types used in lower extremity bypass (LEB) for patients with critical limb ischemia (CLI). The Vascular Study Group of New England database (2003-2014) was queried to identify patients who had an infrageniculate bypass originating from the femoral artery (FA). Conduit types were categorized as single-segment great saphenous vein (GSV), alternative autologous conduit (AAC: arm veins, composite veins), and nonautologous conduit (NAC: cryopreserved vein, prosthetic graft). Primary outcomes were 1-year freedom from major adverse limb event (MALE), MALE-free survival, and primary graft patency. Multivariable Cox regression was used to adjust for demographics and comorbidities. LEB was performed in 2148 patients; 1125 FA-to-below-knee popliteal (bk-Pop) and 1023 FA-to-tibial artery (TA) bypasses (Table). Conduit type did not significantly affect the rate of wound infection, return to operating room, or postoperative length of stay. Patients with AAC had the highest rate of blood transfusion compared with GSV and NAC (Table). In the bk-Pop group, conduit type did not make a difference in 1-year MALE or MALE-free survival, although there was a trend towards worse outcomes associated with the use of AAC (Fig). For TA bypasses, the use of NAC was associated with the highest rate of hospital mortality, primary patency loss, postoperative death, MALE, and MALE-free survival (Table). In adjusted analysis, NAC was associated with higher risk of MALE (hazard ratio, 1.50; 95% confidence interval, 1.03-2.20; P = .036) and MALE-free survival (hazard ratio, 1.47; 95% confidence interval, 1.03-2.09; P = .035) compared with GSV. There was no significant difference in these outcomes between NAC and AAC groups. Conduit type does not affect outcomes in FA-to-bk-Pop bypass. In the absence of single-segment GSV, the use of AAC for tibial bypass does not appear to confer any additional benefit of MALE, MALE-free survival, or graft patency compared with prosthetic grafts at 1 year of follow-up.TablePatient demographics, clinical features, and outcome by conduit typeCharacteristicsbk-Pop bypassTA bypassGSV (N = 849)AAC (N = 36)NAC (N = 240)P valueGSV (N = 763)AAC (N = 104)NAC (N = 156)P valueDemographics Age, median (range), years68 (37-89)67.5 (47-89)72 (44-89)