Recommended Citation
Asha A, Ghandour H, Lian A, et al. Should Non-Autologous Bypass Graft Conduits be Abandoned in the Current Endovascular Era?. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Background/Significance:
As only a minority of patients undergoing infrainguinal bypass grafting will have adequate autogenous vein, alternative non-autogenous conduits are frequently employed. Unfortunately, their clinical performance has historically been so poor that they are often characterized as “last-ditch” efforts. As more and more patients are now successfully treated endovascularly, only the worst candidates may be revascularized using suboptimal conduits.
Purpose:
The purpose of this retrospective clinical study was to assess the contemporary results of lower extremity bypass surgery using commercially-available non-autogenous grafts.
Methods:
Consecutive prosthetic bypasses for peripheral arterial occlusive disease performed at a single institution were included. Patient demographic characteristics, perioperative complications, and limb-specific outcomes were reviewed.
Results:
Between the years 2015 and 2023, a total of 82 consecutive patients underwent infrainguinal bypass grafting using prosthetic conduits (55 cryopreserved veins and 27 PTFE grafts). Most patients were male (62%), white (74%), diabetic (55%) and presenting with chronic limb-threatening ischemia (CLTI; 90%). Comorbidities such as coronary artery disease (76%) and heart failure (44%) were prevalent. The majority of patients presenting with tissue loss exhibited advanced limb threat with 75% having Wound, Ischemia, foot Infection (WIfI) class 3 and 4. Distal bypass targets included the above-knee popliteal artery (n=31), the below-knee popliteal artery (n=18) or the tibio-pedal arteries (n=33). Perioperative complications occurred in 35% of operations including surgical site infections in 21%. After a median follow-up duration of 19 months (IQR=24 months), limb salvage was achieved in 60 patients with CLTI (81%). Reintervention was commonplace (43%) as was the need for multiple reinterventions (12%). Primary bypass patency was maintained in only 52.8±2.3% of patients at 1-year (46.5±3.1% for cryopreserved vein and 70±7.8% for PTFE). 14 patients (19%) who presented with CLTI eventually required major amputation; only one of them had a patent bypass graft before limb loss. Of the 23 patients with tissue loss who achieved wound healing after prosthetic conduit bypass, 13 eventually lost patency.
Conclusions:
If adequate autologous vein is not available for infrainguinal bypass, both the graft and the patient are likely to do poorly. In this contemporary series using either cryopreserved vein or PTFE, the 1-year primary patency was only 52.8±2.3%, and 19% of patients presenting with CLTI required amputation. Given these dismal results, continued development and liberalization of endovascular techniques appears warranted.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
Should Non-Autologous Bypass Graft Conduits be Abandoned in the Current Endovascular Era?
Background/Significance:
As only a minority of patients undergoing infrainguinal bypass grafting will have adequate autogenous vein, alternative non-autogenous conduits are frequently employed. Unfortunately, their clinical performance has historically been so poor that they are often characterized as “last-ditch” efforts. As more and more patients are now successfully treated endovascularly, only the worst candidates may be revascularized using suboptimal conduits.
Purpose:
The purpose of this retrospective clinical study was to assess the contemporary results of lower extremity bypass surgery using commercially-available non-autogenous grafts.
Methods:
Consecutive prosthetic bypasses for peripheral arterial occlusive disease performed at a single institution were included. Patient demographic characteristics, perioperative complications, and limb-specific outcomes were reviewed.
Results:
Between the years 2015 and 2023, a total of 82 consecutive patients underwent infrainguinal bypass grafting using prosthetic conduits (55 cryopreserved veins and 27 PTFE grafts). Most patients were male (62%), white (74%), diabetic (55%) and presenting with chronic limb-threatening ischemia (CLTI; 90%). Comorbidities such as coronary artery disease (76%) and heart failure (44%) were prevalent. The majority of patients presenting with tissue loss exhibited advanced limb threat with 75% having Wound, Ischemia, foot Infection (WIfI) class 3 and 4. Distal bypass targets included the above-knee popliteal artery (n=31), the below-knee popliteal artery (n=18) or the tibio-pedal arteries (n=33). Perioperative complications occurred in 35% of operations including surgical site infections in 21%. After a median follow-up duration of 19 months (IQR=24 months), limb salvage was achieved in 60 patients with CLTI (81%). Reintervention was commonplace (43%) as was the need for multiple reinterventions (12%). Primary bypass patency was maintained in only 52.8±2.3% of patients at 1-year (46.5±3.1% for cryopreserved vein and 70±7.8% for PTFE). 14 patients (19%) who presented with CLTI eventually required major amputation; only one of them had a patent bypass graft before limb loss. Of the 23 patients with tissue loss who achieved wound healing after prosthetic conduit bypass, 13 eventually lost patency.
Conclusions:
If adequate autologous vein is not available for infrainguinal bypass, both the graft and the patient are likely to do poorly. In this contemporary series using either cryopreserved vein or PTFE, the 1-year primary patency was only 52.8±2.3%, and 19% of patients presenting with CLTI required amputation. Given these dismal results, continued development and liberalization of endovascular techniques appears warranted.
Affiliations
Advocate Lutheran General Hospital