The role of infragenicular spliced vein bypass surgery in patients with chronic limb-threatening ischemia: single center long-term results.

BACKGROUND: In patients requiring infrageniculate surgical revascularization a single-segment great saphenous vein (SS-GSV) is the optimal conduit. In the absence of a SS-GSV, the small saphenous vein and arm veins can also be used to obtain an all-autologous bypass. The aim of this study was to compare the long-term results of infrageniculate SS-GSV bypasses and spliced vein bypasses in patients with chronic limb-threatening ischemia (CLTI). METHODS: A total of 308 consecutive CLTI patients who underwent a primary infragenicular, autologous bypass between January 2000 and December 2016 were included. The definition of a spliced vein bypass was a graft consisting of at least two venous segments. RESULTS: A SS-GSV graft was used in 235 patients, and a spliced vein graft was used in 73 patients. Significantly more infrapopliteal bypasses were performed in the spliced vein group (P=0.024), and in this group the mean operation time was almost 60 minutes longer (P<0.001). The overall morbidity rate was 44%. The overall 30-day mortality was 3.2%, and overall in-hospital mortality was 4.9%. No significant differences were observed between the groups in mortality, overall morbidity or any specific complication. Comparing the SS-GSV group with the spliced vein group, no significant differences were observed between overall survival (53.2% vs. 45.7%), primary patency (55.5% vs. 53.2%), assisted primary patency (78.5% vs. 76.5%), secondary patency (87.9% vs. 90.6%) and limb salvage (83.3% vs. 82.0%). CONCLUSIONS: The use of infrageniculate spliced vein bypasses for the treatment of CLTI patients results in similar results compared with infrageniculate SS-GSV bypass grafts. A strict surveillance protocol in the first 2 years and a liberal reintervention strategy may result in excellent long-term patency rates.

Endovascular Treatment of Common Iliac Artery Aneurysms With an Iliac Branch Device: Multicenter Experience of 140 Patients.

PURPOSE: To evaluate the efficacy, feasibility, and long-term outcomes of the Zenith ZBIS iliac branch device (IBD) to preserve internal iliac artery (IIA) perfusion in a large Dutch multicenter cohort. METHODS: Between September 2004 and August 2015, 140 patients (mean age 70.9±7.4 years; 130 men) with 162 IBD implantations were identified in 7 vascular centers. The indication for IBD implantation was an abdominal aortic aneurysm >55 mm with a concomitant common iliac artery (CIA) aneurysm >20 mm (n=40), a CIA aneurysm with a diameter >30 mm (n=89), or revision of a type Ib endoleak after endovascular aneurysm repair (n=11). RESULTS: Technical success (aneurysm exclusion, no type I or III endoleak, and a patent IIA) was obtained in 157 (96.9%) of 162 IBD implantations. Six (4.3%) patients developed major complications; 2 (1.4%) died. Mean follow-up was 26.6±24.1 months, during which 17 (12.1%) IBD-associated secondary interventions were performed. Including technical failures and intentional IIA embolizations, 15 (9.3%) IIA branch occlusions were identified; buttock claudication developed in 6 of these patients. The freedom from secondary intervention estimate was 75.9% (95% confidence interval 59.7 to 86.3) at 5 years. CONCLUSION: CIA aneurysms can be treated safely and effectively by IBDs with preservation of antegrade flow to the IIA. Secondary interventions are indicated in >10% of patients during follow-up but can be performed endovascularly in most.

Secondary interventions in patients with autologous infrainguinal bypass grafts strongly improve patency rates.

OBJECTIVE: To describe the patency of percutaneous transluminal angioplasty (PTA) of autologous infrainguinal bypasses at risk. METHODS: This was a retrospective single-center cohort study of consecutive patients who underwent primary PTA of an infrainguinal autologous bypass at risk from January 2009 to December 2013. Duplex ultrasound surveillance was performed for at least 1 year after PTA. The primary study end point was the number of secondary interventions. Secondary end points were freedom from recurrent stenosis or bypass occlusion and the patency of the infrainguinal autologous bypass at 1 year after primary PTA. RESULTS: A total of 69 infrainguinal bypasses at risk in 69 patients were identified and treated with PTA. Technical success was achieved in 91%. The median follow-up was 17 months (range, 1-58 months). During follow-up, 30 bypasses (43%) remained free of significant stenosis or bypass occlusion, 29 bypasses (42%) developed recurrent stenosis, and 10 bypasses (14%) occluded. Rates of primary assisted, and secondary patency at 1 year were 84%, and 86%. Five (7%) major amputations were performed, all after bypass occlusion. CONCLUSIONS: Secondary interventions after PTA of a bypass at risk are common. However, repeated secondary interventions of autologous infrainguinal bypasses at risk result in patency rates of more than 80% at 1 year.