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- Title
Single Tertiary Care Center Outcomes After Lower Extremity Cadaveric Vein Bypass for Limb Salvage.
- Authors
Singh, Kuldeep; Juneja, Amandeep; Bajaj, Tushar; Voto, Christian; Schor, Jonathan; Zia, Saqib; Deitch, Jonathan
- Abstract
Objective: Cadaveric saphenous vein (CV) conduits are used in rare instances for limb salvage in patients without autogenous veins although long-term outcome data are scarce. This study was designed to evaluate the outcomes of CV bypass in patients with threatened limbs. Methods: We retrospectively reviewed the charts from 2010 to 2017 of 25 patients who underwent 30 CV allografts for critical limb ischemia and acute limb ischemia. Patient charts were reviewed for demographics, comorbidities, smoking status, indications for bypass, and outcomes. Primary outcomes included graft patency, major amputation rates, and mortality. Secondary outcomes measured included infection rates, 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE). Statistical analysis was performed using time series and Kaplan-Meier survival curves. Results: A total of 30 limbs received CV lower extremity bypasses (20 males, 10 female), and the average age was 68 ± 4 years. Primary patency rates were 71%, 42%, and 28% at 3, 6, and 12 months, respectively. Assisted primary patency rates were 78%, 56%, and 37% at 3, 6, and 12 months, respectively. Secondary patency rates were 77%, 59%, and 28% at 3, 6, and 12 months, respectively. Minor amputations, defined as amputations below the transmetatarsal level occurred in 5 (20%) patients. Wound infection occurred in 8 (32%) patients which was managed with local wound care and no patients required an extraanatomic bypass for limb salvage. Thirty-day MALE occurred in 7 (23.3%) patients. We had no 30-day mortality or MACE. The average graft length was 64.2 ± 8 cm with an average graft diameter of 3.9 ± 2 mm. Amputation-free survival and overall survival at 12 months were 20 (68%) and 21 (84%), respectively. Conclusions: Cadaveric saphenous vein allograft may be used as a bypass conduit as a viable surgical option before limb amputation. Despite the poor patency rates, the limb salvage rates of cadaveric vein grafts demonstrate that this alternate conduit may be considered when no autogenous vein is available.
- Subjects
FLORIDA; LEG surgery; MORTALITY risk factors; AMPUTATION; CARDIOVASCULAR diseases risk factors; CONFERENCES &; conventions; HOMOGRAFTS; ISCHEMIA; LEG; LIMB salvage; MEDICAL records; RISK assessment; SAPHENOUS vein; SMOKING; STATISTICS; SURVIVAL analysis (Biometry); WOUND infections; COMORBIDITY; DATA analysis; TREATMENT effectiveness; RETROSPECTIVE studies; KAPLAN-Meier estimator; ACQUISITION of data methodology; TERTIARY care
- Publication
Vascular & Endovascular Surgery, 2020, Vol 54, Issue 5, p430
- ISSN
1538-5744
- Publication type
Article
- DOI
10.1177/1538574420925586