ABSTRACT
BACKGROUND: The percentage of women requiring infrainguinal bypass graft operations continues to increase, whereas the effect of gender on postoperative outcome remains unclear. The purpose of this study was to assess the influence of gender on patient selection and outcome in patients requiring infrainguinal vein bypass grafting procedures. METHODS: This retrospective study reviewed 217 infrainguinal vein bypass grafts performed over an 8-year period. Medical records and patient interviews were used to determine study measures and outcomes. Gender and multiple covariables affecting patient survival were analyzed; postoperative complications and graft patencies were examined. Bivariate and life-table analyses were conducted, followed by multivariate analysis with the Cox proportional hazards model. RESULTS: No statistical differences existed between men and women for age, diabetes, cardiac disease, tobacco use, hypertension, stroke, renal disease, or prior contralateral bypass or major amputation. Women were more likely to be black (P =.014) and have a spliced vein graft (P =.035). No differences were noted between the 2 groups for 30-day morbidity rates-except women had more incisional complications (P =.01)-or for survival (P =.45), primary-patency (P =.57), secondary-patency (P =. 79), or limb-salvage rates (P =.40). Multivariate analysis showed that gender had no role in affecting survival rates. CONCLUSIONS: Gender does not affect graft patency, limb salvage, or survival rates. There should be no introduction of a gender bias into management of infrainguinal occlusive disease.
Subject(s)
Blood Vessel Prosthesis Implantation , Peripheral Vascular Diseases/surgery , Adult , Aged , Aged, 80 and over , Blood Vessel Prosthesis Implantation/adverse effects , Female , Humans , Inguinal Canal , Male , Middle Aged , Peripheral Vascular Diseases/mortality , Retrospective Studies , Sex Factors , Survival Rate , Treatment Outcome , Veins/surgeryABSTRACT
The purpose of this study was to examine the role of diabetes mellitus (DM) in infrainguinal bypass graft outcome. One hundred forty-four patients who underwent 170 infrainguinal bypass grafts from 1990 to 1995 were reviewed retrospectively. Seventy-eight patients (94 bypasses) had DM and were followed for an average of 15.4 months; 13 patients were lost to follow up. The mean age was 68 years; 44 (56.4%) were men. The major indication for intervention was limb salvage for the DM (87/94, 92.6%) and non-DM (56/76, 73.7%) groups. No significant difference was found for perioperative wound complications, hematoma, myocardial infarction, or deep venous thrombosis between the DM and non-DM groups. Early mortalities were three for DM and one for non-DM patients. No significant difference was found between primary patency (p = 0.71), secondary patency (p = 0.32), limb salvage (p = 0.99), and survival (p = 0.72) between DM and non-DM groups. DM patients were more likely to have significant tissue loss (p = 0.009) and a longer hospital stay (p = 0.01). In conclusion, infrainguinal vein bypass grafting can be performed successfully in diabetic patients with comparable patency and limb-salvage rates to those without DM.
Subject(s)
Arteriovenous Shunt, Surgical , Diabetic Angiopathies/surgery , Peripheral Vascular Diseases/surgery , Aged , Arteriosclerosis Obliterans/etiology , Arteriosclerosis Obliterans/surgery , Diabetic Angiopathies/complications , Female , Humans , Inguinal Canal , Leg/blood supply , Male , Middle Aged , Peripheral Vascular Diseases/etiology , Postoperative Complications , Retrospective Studies , Vascular PatencyABSTRACT
The purpose of this study is to determine the role of renal failure (RF) in infrainguinal bypass graft outcome. From 1990 through 1996, 206 patients underwent 241 infrainguinal bypass grafts at two institutions. Thirty-three RF patients (42 bypasses) had a mean follow-up of 14.0 months and a mean age of 67.7 years, and 21 (64%) were male. Risk factors included hypertension (100%), diabetes (81.8%), and cardiac disease (75.8%). RF patients included 20 with end-stage renal disease (ESRD) and 14 with renal insufficiency (RI). One patient had RI during his first bypass and ESRD for his subsequent bypass. The major operative indication was limb salvage (90.5%). Total perioperative morbidity for ESRD was significantly higher than for RI and non-RF groups (P = 0.019). Early mortalities occurred in three ESRD, no RI, and seven non-RF patients. Life table analysis demonstrated no significant difference between primary patency (P = 0.56), secondary patency (P = 0.96), and limb salvage (P = 0.69) between ESRD and non-RF groups. However, there was an overall decreased survival rate in the ESRD group (P < 0.01). In conclusion, infrainguinal vein bypass grafting can be successfully performed in RF patients with comparable patency and limb salvage rates and therefore improve quality of life. However, perioperative morbidity was higher in ESRD and survival was significantly shorter for RF than for non-RF patients.
