Long-Term Outcomes of Extra-Anatomic Femoro-Tibial Bypass Reconstructions in Chronic Limb-Threating Ischemia
(1) Background: While tibial bypass surgery still plays a role in the treatment of patients with chronic limb-threatening ischemia and diabetic foot syndrome; only a few centers have recorded considerable numbers of these conditions. The current study aimed to determine contemporary practice with sp...
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| Format: | Article |
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MDPI AG
2022-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/5/1237 |
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| author | Alexander Meyer Evgenia Boxberger Christian-Alexander Behrendt Shatlyk Yagshyyev Irina Welk Werner Lang Ulrich Rother |
| author_facet | Alexander Meyer Evgenia Boxberger Christian-Alexander Behrendt Shatlyk Yagshyyev Irina Welk Werner Lang Ulrich Rother |
| author_sort | Alexander Meyer |
| collection | DOAJ |
| description | (1) Background: While tibial bypass surgery still plays a role in the treatment of patients with chronic limb-threatening ischemia and diabetic foot syndrome; only a few centers have recorded considerable numbers of these conditions. The current study aimed to determine contemporary practice with special focus on the performance of extra-anatomic grafting to the infrapopliteal arteries. (2) Methods: A retrospective, single-center study included patients with tibial bypass grafts from 1 January 2008 to 31 December 2019. Primary endpoints were complication rate, graft patency, amputation, overall survival, and major adverse cardiac (MACE) or limb event (MALE). The cohort was stratified by extra-anatomic vs. anatomic position. (3) Results: A total of 455 patients (31% female) with Rutherford stage 4 (12.5%) and 5/6 (69.5%) were included (thereof, 19.5% had high amputation risk according to the Wound Ischemia Foot Infection score). Autologous reconstruction was performed in 316 cases, and prosthetic reconstruction in 131 cases, with a total of 51 (11.2%) extra-anatomic grafts. Early occlusion rate was 9.0% with an in-hospital overall mortality of 2.8%. The in-hospital rate of MACE was 2.4% and of MALE, 1.5%. After one, three and five years, the primary patency of venous bypasses was 74.5%, 68.6% and 61.7%, respectively. For prosthetic grafts, this was 55.1%, 46.0%, and 38.3%, respectively (<i>p</i> < 0.001). The patency of extra-anatomic prosthetic grafts performed significantly better compared with anatomically positioned prosthetic grafts (log-rank <i>p</i> = 0.008). In multivariate analyses, diabetes (hazard ratio, HR 1.314, CI 1.023–1.688, <i>p</i> = 0.032), coronary artery disease (HR 1.343, CI 1.041–1.732, <i>p</i> = 0.023), and dialysis dependency (HR 2.678, CI 1.687–4.250, <i>p</i> < 0.001) were associated with lower odds of survival (4) Conclusion: In this large, single-center cohort, tibial bypass surgery demonstrated satisfactory results with overall low perioperative complication rates and long-term patency rates of 60% and 38%, respectively. Extra-anatomic bypasses represent a feasible alternative to venous grafts in terms of patency. A tailored, patient-centered approach considering predictors such as diabetes, dialysis dependency, and coronary artery disease along with prediction models may further improve the long-term results in the future. |
| first_indexed | 2024-03-09T20:35:23Z |
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| id | doaj.art-d2478e86ec684769899ad91b4ecefebd |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T20:35:23Z |
| publishDate | 2022-02-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-d2478e86ec684769899ad91b4ecefebd2023-11-23T23:12:54ZengMDPI AGJournal of Clinical Medicine2077-03832022-02-01115123710.3390/jcm11051237Long-Term Outcomes of Extra-Anatomic Femoro-Tibial Bypass Reconstructions in Chronic Limb-Threating IschemiaAlexander Meyer0Evgenia Boxberger1Christian-Alexander Behrendt2Shatlyk Yagshyyev3Irina Welk4Werner Lang5Ulrich Rother6Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, GermanyDepartment of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, GermanyResearch Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, GermanyDepartment of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, GermanyDepartment of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, GermanyDepartment of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, GermanyDepartment of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany(1) Background: While tibial bypass surgery still plays a role in the treatment of patients with chronic limb-threatening ischemia and diabetic foot syndrome; only a few centers have recorded considerable numbers of these conditions. The current study aimed to determine contemporary practice with special focus on the performance of extra-anatomic grafting to the infrapopliteal arteries. (2) Methods: A retrospective, single-center study included patients with tibial bypass grafts from 1 January 2008 to 31 December 2019. Primary endpoints were complication rate, graft patency, amputation, overall survival, and major adverse cardiac (MACE) or limb event (MALE). The cohort was stratified by extra-anatomic vs. anatomic position. (3) Results: A total of 455 patients (31% female) with Rutherford stage 4 (12.5%) and 5/6 (69.5%) were included (thereof, 19.5% had high amputation risk according to the Wound Ischemia Foot Infection score). Autologous reconstruction was performed in 316 cases, and prosthetic reconstruction in 131 cases, with a total of 51 (11.2%) extra-anatomic grafts. Early occlusion rate was 9.0% with an in-hospital overall mortality of 2.8%. The in-hospital rate of MACE was 2.4% and of MALE, 1.5%. After one, three and five years, the primary patency of venous bypasses was 74.5%, 68.6% and 61.7%, respectively. For prosthetic grafts, this was 55.1%, 46.0%, and 38.3%, respectively (<i>p</i> < 0.001). The patency of extra-anatomic prosthetic grafts performed significantly better compared with anatomically positioned prosthetic grafts (log-rank <i>p</i> = 0.008). In multivariate analyses, diabetes (hazard ratio, HR 1.314, CI 1.023–1.688, <i>p</i> = 0.032), coronary artery disease (HR 1.343, CI 1.041–1.732, <i>p</i> = 0.023), and dialysis dependency (HR 2.678, CI 1.687–4.250, <i>p</i> < 0.001) were associated with lower odds of survival (4) Conclusion: In this large, single-center cohort, tibial bypass surgery demonstrated satisfactory results with overall low perioperative complication rates and long-term patency rates of 60% and 38%, respectively. Extra-anatomic bypasses represent a feasible alternative to venous grafts in terms of patency. A tailored, patient-centered approach considering predictors such as diabetes, dialysis dependency, and coronary artery disease along with prediction models may further improve the long-term results in the future.https://www.mdpi.com/2077-0383/11/5/1237tibial bypass surgeryCLTIprosthetic bypass graftsextra-anatomic bypass reconstruction |
| spellingShingle | Alexander Meyer Evgenia Boxberger Christian-Alexander Behrendt Shatlyk Yagshyyev Irina Welk Werner Lang Ulrich Rother Long-Term Outcomes of Extra-Anatomic Femoro-Tibial Bypass Reconstructions in Chronic Limb-Threating Ischemia Journal of Clinical Medicine tibial bypass surgery CLTI prosthetic bypass grafts extra-anatomic bypass reconstruction |
| title | Long-Term Outcomes of Extra-Anatomic Femoro-Tibial Bypass Reconstructions in Chronic Limb-Threating Ischemia |
| title_full | Long-Term Outcomes of Extra-Anatomic Femoro-Tibial Bypass Reconstructions in Chronic Limb-Threating Ischemia |
| title_fullStr | Long-Term Outcomes of Extra-Anatomic Femoro-Tibial Bypass Reconstructions in Chronic Limb-Threating Ischemia |
| title_full_unstemmed | Long-Term Outcomes of Extra-Anatomic Femoro-Tibial Bypass Reconstructions in Chronic Limb-Threating Ischemia |
| title_short | Long-Term Outcomes of Extra-Anatomic Femoro-Tibial Bypass Reconstructions in Chronic Limb-Threating Ischemia |
| title_sort | long term outcomes of extra anatomic femoro tibial bypass reconstructions in chronic limb threating ischemia |
| topic | tibial bypass surgery CLTI prosthetic bypass grafts extra-anatomic bypass reconstruction |
| url | https://www.mdpi.com/2077-0383/11/5/1237 |
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