Limb salvage after infrainguinal bypass graft failure

Zachary K. Baldwin, Benjamin J. Pearce, Michael Curi, Tina R. Desai, James F. McKinsey, Hisham S. Bassiouny, Daniel Katz, Bruce L. Gewertz, Lewis B. Schwartz, Peter K. Henke, Timothy Baxter

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objective: The purpose of this study was to examine the outcome of patients in whom an infrainguinal bypass graft failed. Methods: This was a retrospective analysis of consecutive patients undergoing infrainguinal bypass grafting in a single institution over 8 years. Results: Six hundred thirty-one infrainguinal bypass grafts were placed in 578 limbs in 503 patients during the study period. The indication for surgery was limb-threatening ischemia in 533 patients (85%); nonautologous conduits were used in 259 patients (41%), and 144 (23%) were repeat operations. After a mean follow-up of 28 ± 1 months (median, 23 months; range, 0-99 months), 167 grafts (26%) had failed secondarily. The rate of limb salvage in patients with graft failure was poor, only 50% ± 5% at 2 years after failure. The 2-year limb salvage rate depended on the initial indication for bypass grafting: 100% in patients with claudication (n = 16), 55% ± 8% in patients with rest pain (n = 49), and 34% ± 6% in patients with tissue loss (n = 73; P < .001). The prospect for limb salvage also depended on the duration that the graft remained patent. Early graft failure (<30 days; n = 25) carried a poor prognosis, with 2-year limb salvage of only 25% ± 10%; limb salvage was 53% ± 5% after intermediate graft failure (<2 years, n = 110) and 79% ± 10% after late failure (> 2 years, n = 15; P = .04). Multivariate analysis revealed shorter patency interval before failure (P = .006), use of warfarin sodium (Coumadin) postoperatively (P = .006), and infrapopliteal distal anastomosis (P = .01) as significant predictors for ultimate limb loss. Conclusion: The overall prognosis for limb salvage in patients with failed infrainguinal bypass grafts is poor, particularly in patients with grafts placed because of tissue loss and those with early graft failure.

Original languageEnglish (US)
Pages (from-to)951-957
Number of pages7
JournalJournal of Vascular Surgery
Volume39
Issue number5
DOIs
StatePublished - Jan 1 2004
Externally publishedYes

Fingerprint

Limb Salvage
Transplants
Extremities
Warfarin
Multivariate Analysis
Ischemia

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Baldwin, Z. K., Pearce, B. J., Curi, M., Desai, T. R., McKinsey, J. F., Bassiouny, H. S., ... Baxter, T. (2004). Limb salvage after infrainguinal bypass graft failure. Journal of Vascular Surgery, 39(5), 951-957. https://doi.org/10.1016/j.jvs.2004.01.027
Baldwin, Zachary K. ; Pearce, Benjamin J. ; Curi, Michael ; Desai, Tina R. ; McKinsey, James F. ; Bassiouny, Hisham S. ; Katz, Daniel ; Gewertz, Bruce L. ; Schwartz, Lewis B. ; Henke, Peter K. ; Baxter, Timothy. / Limb salvage after infrainguinal bypass graft failure. In: Journal of Vascular Surgery. 2004 ; Vol. 39, No. 5. pp. 951-957.
@article{83a1527a605d49c6b2afd5a5e6aa6a2c,
title = "Limb salvage after infrainguinal bypass graft failure",
abstract = "Objective: The purpose of this study was to examine the outcome of patients in whom an infrainguinal bypass graft failed. Methods: This was a retrospective analysis of consecutive patients undergoing infrainguinal bypass grafting in a single institution over 8 years. Results: Six hundred thirty-one infrainguinal bypass grafts were placed in 578 limbs in 503 patients during the study period. The indication for surgery was limb-threatening ischemia in 533 patients (85{\%}); nonautologous conduits were used in 259 patients (41{\%}), and 144 (23{\%}) were repeat operations. After a mean follow-up of 28 ± 1 months (median, 23 months; range, 0-99 months), 167 grafts (26{\%}) had failed secondarily. The rate of limb salvage in patients with graft failure was poor, only 50{\%} ± 5{\%} at 2 years after failure. The 2-year limb salvage rate depended on the initial indication for bypass grafting: 100{\%} in patients with claudication (n = 16), 55{\%} ± 8{\%} in patients with rest pain (n = 49), and 34{\%} ± 6{\%} in patients with tissue loss (n = 73; P < .001). The prospect for limb salvage also depended on the duration that the graft remained patent. Early graft failure (<30 days; n = 25) carried a poor prognosis, with 2-year limb salvage of only 25{\%} ± 10{\%}; limb salvage was 53{\%} ± 5{\%} after intermediate graft failure (<2 years, n = 110) and 79{\%} ± 10{\%} after late failure (> 2 years, n = 15; P = .04). Multivariate analysis revealed shorter patency interval before failure (P = .006), use of warfarin sodium (Coumadin) postoperatively (P = .006), and infrapopliteal distal anastomosis (P = .01) as significant predictors for ultimate limb loss. Conclusion: The overall prognosis for limb salvage in patients with failed infrainguinal bypass grafts is poor, particularly in patients with grafts placed because of tissue loss and those with early graft failure.",
author = "Baldwin, {Zachary K.} and Pearce, {Benjamin J.} and Michael Curi and Desai, {Tina R.} and McKinsey, {James F.} and Bassiouny, {Hisham S.} and Daniel Katz and Gewertz, {Bruce L.} and Schwartz, {Lewis B.} and Henke, {Peter K.} and Timothy Baxter",
year = "2004",
month = "1",
day = "1",
doi = "10.1016/j.jvs.2004.01.027",
language = "English (US)",
volume = "39",
pages = "951--957",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "5",

}

Baldwin, ZK, Pearce, BJ, Curi, M, Desai, TR, McKinsey, JF, Bassiouny, HS, Katz, D, Gewertz, BL, Schwartz, LB, Henke, PK & Baxter, T 2004, 'Limb salvage after infrainguinal bypass graft failure', Journal of Vascular Surgery, vol. 39, no. 5, pp. 951-957. https://doi.org/10.1016/j.jvs.2004.01.027

Limb salvage after infrainguinal bypass graft failure. / Baldwin, Zachary K.; Pearce, Benjamin J.; Curi, Michael; Desai, Tina R.; McKinsey, James F.; Bassiouny, Hisham S.; Katz, Daniel; Gewertz, Bruce L.; Schwartz, Lewis B.; Henke, Peter K.; Baxter, Timothy.

In: Journal of Vascular Surgery, Vol. 39, No. 5, 01.01.2004, p. 951-957.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Limb salvage after infrainguinal bypass graft failure

AU - Baldwin, Zachary K.

AU - Pearce, Benjamin J.

AU - Curi, Michael

AU - Desai, Tina R.

AU - McKinsey, James F.

AU - Bassiouny, Hisham S.

AU - Katz, Daniel

AU - Gewertz, Bruce L.

AU - Schwartz, Lewis B.

AU - Henke, Peter K.

AU - Baxter, Timothy

PY - 2004/1/1

Y1 - 2004/1/1

N2 - Objective: The purpose of this study was to examine the outcome of patients in whom an infrainguinal bypass graft failed. Methods: This was a retrospective analysis of consecutive patients undergoing infrainguinal bypass grafting in a single institution over 8 years. Results: Six hundred thirty-one infrainguinal bypass grafts were placed in 578 limbs in 503 patients during the study period. The indication for surgery was limb-threatening ischemia in 533 patients (85%); nonautologous conduits were used in 259 patients (41%), and 144 (23%) were repeat operations. After a mean follow-up of 28 ± 1 months (median, 23 months; range, 0-99 months), 167 grafts (26%) had failed secondarily. The rate of limb salvage in patients with graft failure was poor, only 50% ± 5% at 2 years after failure. The 2-year limb salvage rate depended on the initial indication for bypass grafting: 100% in patients with claudication (n = 16), 55% ± 8% in patients with rest pain (n = 49), and 34% ± 6% in patients with tissue loss (n = 73; P < .001). The prospect for limb salvage also depended on the duration that the graft remained patent. Early graft failure (<30 days; n = 25) carried a poor prognosis, with 2-year limb salvage of only 25% ± 10%; limb salvage was 53% ± 5% after intermediate graft failure (<2 years, n = 110) and 79% ± 10% after late failure (> 2 years, n = 15; P = .04). Multivariate analysis revealed shorter patency interval before failure (P = .006), use of warfarin sodium (Coumadin) postoperatively (P = .006), and infrapopliteal distal anastomosis (P = .01) as significant predictors for ultimate limb loss. Conclusion: The overall prognosis for limb salvage in patients with failed infrainguinal bypass grafts is poor, particularly in patients with grafts placed because of tissue loss and those with early graft failure.

AB - Objective: The purpose of this study was to examine the outcome of patients in whom an infrainguinal bypass graft failed. Methods: This was a retrospective analysis of consecutive patients undergoing infrainguinal bypass grafting in a single institution over 8 years. Results: Six hundred thirty-one infrainguinal bypass grafts were placed in 578 limbs in 503 patients during the study period. The indication for surgery was limb-threatening ischemia in 533 patients (85%); nonautologous conduits were used in 259 patients (41%), and 144 (23%) were repeat operations. After a mean follow-up of 28 ± 1 months (median, 23 months; range, 0-99 months), 167 grafts (26%) had failed secondarily. The rate of limb salvage in patients with graft failure was poor, only 50% ± 5% at 2 years after failure. The 2-year limb salvage rate depended on the initial indication for bypass grafting: 100% in patients with claudication (n = 16), 55% ± 8% in patients with rest pain (n = 49), and 34% ± 6% in patients with tissue loss (n = 73; P < .001). The prospect for limb salvage also depended on the duration that the graft remained patent. Early graft failure (<30 days; n = 25) carried a poor prognosis, with 2-year limb salvage of only 25% ± 10%; limb salvage was 53% ± 5% after intermediate graft failure (<2 years, n = 110) and 79% ± 10% after late failure (> 2 years, n = 15; P = .04). Multivariate analysis revealed shorter patency interval before failure (P = .006), use of warfarin sodium (Coumadin) postoperatively (P = .006), and infrapopliteal distal anastomosis (P = .01) as significant predictors for ultimate limb loss. Conclusion: The overall prognosis for limb salvage in patients with failed infrainguinal bypass grafts is poor, particularly in patients with grafts placed because of tissue loss and those with early graft failure.

UR - http://www.scopus.com/inward/record.url?scp=2342648839&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2342648839&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2004.01.027

DO - 10.1016/j.jvs.2004.01.027

M3 - Article

VL - 39

SP - 951

EP - 957

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 5

ER -

Baldwin ZK, Pearce BJ, Curi M, Desai TR, McKinsey JF, Bassiouny HS et al. Limb salvage after infrainguinal bypass graft failure. Journal of Vascular Surgery. 2004 Jan 1;39(5):951-957. https://doi.org/10.1016/j.jvs.2004.01.027