Factors influencing infrainguinal reverse vein bypass patency at Universitas Academic Hospital: a retrospective review
Loading...
Date
2020-09
Authors
Khambule, M. L.
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Introduction and Aim: Peripheral arterial disease is a serious global healthcare concern with a subgroup of patients requiring revascularisation for chronic limb-threatening ischaemia. Open bypass surgery remain a valuable tool in the armamentarium of revascularisation options and several factors are known to affect the patency of a bypass procedure. Literature in this regard is, however, lacking in the South African population. Methods: This was a retrospective cohort analytic study of infrainguinal reverse vein bypasses performed at a central academic hospital in South Africa between January 2012 and December 2016 for the indication of chronic limb-threatening ischaemia. 211 patients with a total of 219 bypass procedures were included. Patency data was assessed for 138 bypasses with 79 patients (36.1%) lost to follow-up and 2 patients (0.9%) who demised. Results: 156 (73.9%) were males and 55 (26.1%) were females. The median age was 61 years. The majority of the patients (78.2%) had hypertension and were known smokers (83.4%), whereas only 32.2% had diabetes mellitus and 11.4% had renal impairment. The human immunodeficiency virus status was unknown in the majority (70.6%) of patients. 83.1% of bypasses were performed for the indication of tissue loss in addition to rest pain. The proximal anastomosis was performed from the common femoral artery in 47.9% of cases and the distal anastomosis to the tibialis posterior artery in 27.9% of cases. Most patients (26.9%) had a single vessel runoff. The median diameter of greater saphenous vein utilised was 2.7mm. 26.1% of grafts demonstrated early graft failure within 30 days compared to 45.7% demonstrating patency beyond 12 months. Age, race, hypertension, diabetes, renal failure, the presence of tissue loss, level of the proximal and distal anastomoses and number of runoff vessels had no significant effect on graft patency. Female gender, a small greater saphenous diameter as well as a single anterior tibial vessel runoff, however, proved to be statistically significant indicators of early graft failure. Smoking, on the other hand, was associated with a longer graft patency beyond 12 months. Conclusions: Female gender, small vein diameter and a single anterior tibial runoff vessel are independent predictors of early graft failure. Smoking, on the other hand, is associated with prolonged patency beyond 12 months which is in contrast to the majority of existing literature.
Description
Keywords
Dissertation (M.Med.Sc. (Surgery))--University of the Free State, 2020, Bypass, Chronic limb-threatening ischaemia, Critical limb ischaemia, Infrainguinal, Patency, Revascularisation, Vein