Outcomes of Prosthetic and Biological Grafts Compared to Arm Vein Grafts in Patients with Chronic Limb Threatening Ischemia.

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Journal of Vascular Surgery Pub Date : 2024-10-26 DOI:10.1016/j.jvs.2024.10.069
Mohammed Hamouda, Sina Zarrintan, Nishita Vootukuru, Sneha Thandra, Jon G Quatromoni, Mahmoud B Malas, Ann C Gaffey
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Abstract

Objectives: The optimal conduit for infrainguinal bypass (IIB) is single segment great saphenous vein (GSV). Unfortunately, GSV is not always available in patients with chronic limb threatening ischemia (CLTI). Other graft choices include arm vein grafts (AV), prosthetic grafts (PG) or biologic grafts (BG). Current data regarding the durability and limb salvage rates of those options is scarce, hence we aimed to investigate the impact of alternative graft types on post-operative and long-term outcomes on IIB in patients with CLTI.

Methods: The Vascular Quality Initiative (VQI) database was queried for patients undergoing IIB from January 2003 to April 2024. Patients were stratified into three groups: arm vein (cephalic, basilic), prosthetic grafts [Dacron, polytetrafluoroethylene (PTFE)], and biologic grafts (cadaveric, homograft, or xenograft). Saphenous vein grafts (greater and lesser saphenous) were excluded. Multivariate logistic regression analyzed postoperative outcomes: 30-day mortality, major adverse cardiovascular events (MACE), graft occlusion, prolonged length of stay >7days (PLOS), packed red blood cell (pRBC) transfusion >2 units, and infection. Cox Regression was used to report one-year outcomes: mortality, major amputation (above-ankle), and major adverse limb events (MALE defined as major amputation, thrombectomy or reintervention).

Results: A total of 9165 IIB procedures have been analyzed: AV 417 (4.55%); PG 7520 (82.05%); BG 1228 (13.40%). Compared to AV, patients receiving PG had higher odds of infection (aOR 2.89, p=0.045) and higher hazard of one-year mortality (aHR 1.51, p=0.035). On the other hand, patients receiving BG had higher risk of graft occlusion (aOR 4.55, p=0.040) and infection (aOR 2.78, p=0.046) as well higher hazard of one-year mortality (aHR 1.53, p=0.040), amputation (aHR 1.72, p=0.019) and amputation or death (aHR 1.52, p=0.005) compared to AV. After stratifying by bypass configuration, AV had the highest overall survival and amputation-free survival among the three alternative conduits in below-knee popliteal and tibial bypass targets.

Conclusions: In this large multi-institutional study investigating alternative conduits to GSV, AV are found to be the most resistant to infections and are associated with the best overall survival and limb salvage outcomes compared to PG and BG particularly in below-knee distal targets. In cases where no GSV is available, AV and PG are acceptable alternatives with comparable one-year amputation-free survival and MALE-free survival rates. On the other hand, BG are associated with higher risk of graft occlusion and lower freedom from major amputation and death compared to AV.

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在慢性肢体缺血患者中,假体和生物移植物与臂静脉移植物的疗效比较。
目的:腹股沟下搭桥术(IIB)的最佳导管是单段大隐静脉(GSV)。遗憾的是,慢性肢体威胁性缺血(CLTI)患者并非总能获得大隐静脉。其他移植物选择包括臂静脉移植物(AV)、假体移植物(PG)或生物移植物(BG)。目前有关这些选择的耐久性和肢体挽救率的数据很少,因此我们旨在研究替代移植物类型对 CLTI 患者 IIB 术后和长期疗效的影响:方法:我们在血管质量倡议(VQI)数据库中查询了 2003 年 1 月至 2024 年 4 月期间接受 IIB 手术的患者。患者被分为三组:臂静脉(头静脉、基底静脉)、人工移植物[达克龙、聚四氟乙烯(PTFE)]和生物移植物(尸体、同种移植物或异种移植物)。大隐静脉移植物(大隐静脉和小隐静脉)除外。多变量逻辑回归分析了术后结果:30天死亡率、主要不良心血管事件(MACE)、移植物闭塞、住院时间延长>7天(PLOS)、充盈红细胞(pRBC)输血>2个单位和感染。Cox回归用于报告一年的结果:死亡率、主要截肢(踝关节以上)和主要肢体不良事件(MALE定义为主要截肢、血栓切除术或再介入):结果:共分析了 9165 例 IIB 手术:AV为417例(4.55%);PG为7520例(82.05%);BG为1228例(13.40%)。与 AV 相比,接受 PG 的患者发生感染的几率更高(aOR 2.89,p=0.045),一年内死亡的风险更高(aHR 1.51,p=0.035)。另一方面,与 AV 相比,接受 BG 的患者发生移植物闭塞(aOR 4.55,p=0.040)和感染(aOR 2.78,p=0.046)的风险更高,一年死亡率(aHR 1.53,p=0.040)、截肢(aHR 1.72,p=0.019)和截肢或死亡(aHR 1.52,p=0.005)的风险也更高。根据旁路结构进行分层后,在膝下腘窝和胫骨旁路目标的三种替代导管中,AV的总生存率和无截肢生存率最高:在这项大型多机构研究中,研究人员对 GSV 的替代导管进行了调查,结果发现 AV 的抗感染能力最强,与 PG 和 BG 相比,AV 的总体存活率和肢体挽救效果最好,尤其是在膝下远端目标中。在没有 GSV 的情况下,AV 和 PG 是可以接受的替代方案,其一年无截肢存活率和无畸形存活率相当。另一方面,与 AV 相比,BG 与较高的移植物闭塞风险和较低的无截肢率和无死亡率相关。
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来源期刊
CiteScore
7.70
自引率
18.60%
发文量
1469
审稿时长
54 days
期刊介绍: Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.
期刊最新文献
A Systematic Review to Examine the Impact of Socioeconomic Status on Revascularization for PAD, Carotid Artery Surgery and Aortic Aneurysm Repair Outcomes in the United States. French Multicentric Registry on LUMINOR Drug-Eluting Balloon for Superficial Femoral and Popliteal Arteries. Outcomes of Prosthetic and Biological Grafts Compared to Arm Vein Grafts in Patients with Chronic Limb Threatening Ischemia. Whole aorta imaging shows increased risk for thoracic aortic aneurysms and dilatations in relatives of abdominal aortic aneurysm patients. Long-Term Outcomes of Elective Endovascular versus Open Repair of Popliteal Artery Aneurysms in the VISION Database.
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