METHODS: We queried the Vascular Quality Initiative infrainguinal database from 2003 to 2021 to identify LEB to para-malleolar or pedal/plantar targets. Primary outcomes were graft patency, major adverse limb events [vascular reintervention, above ankle amputation] (MALE), and amputation-free survival at 2 years. Standard statistical methods were utilized.
RESULTS: We identified 2331 LEB procedures (1,265 anterior tibial at ankle/dorsalis pedis, 783 posterior tibial at ankle, 283 tarsal/plantar). The prevalence of LEB bypasses to distal targets has significantly decreased from 13.37% of all LEB procedures in 2003-3.51% in 2021 (P < 0.001). The majority of cases presented with tissue loss (81.25. Common postoperative complications included major adverse cardiac events (8.9%) and surgical site infections (3.6%). Major amputations occurred in 16.8% of patients at 1 year. Postoperative mortality at 1 year was 10%. On unadjusted Kaplan-Meier survival analysis at 2 years, primary patency was 50.56% ± 3.6%, MALE was 63.49% ± 3.27%, and amputation-free survival was 71.71% ± 0.98%. In adjusted analyses [adjusted for comorbidities, indication, conduit type, urgency, prior vascular interventions, graft inflow vessel (femoral/popliteal), concomitant inflow procedures, surgeon and center volume] conduits other than great saphenous vein (P < 0.001) were associated with loss of primary patency and increased MALE. High center volume (>5 procedures/year) was associated with improved primary patency (P = 0.015), and lower MALE (P = 0.021) at 2 years.
CONCLUSIONS: Despite decreased utilization, open surgical bypass to distal targets at the ankle remains a viable option for treatment of IP-CLTI with acceptable patency and amputation-free survival rates at 2 years. Bypasses to distal targets should be performed at high volume centers to optimize graft patency and limb salvage and minimize reinterventions.
方法:我们查询了2003-2021年的VQI腹股沟下数据库,以识别LEB对踝旁或踏板/足底目标。主要结果是移植物通畅,主要不良肢体事件[血管再介入,脚踝以上截肢](男性),和2年无截肢生存率。使用标准统计方法。
结果:我们确定了2331LEB手术(踝关节/足背胫骨前1265,783踝关节胫骨后端,283髌骨/足底)。LEB旁路到远端目标的患病率已从2003年的所有LEB程序的13.37%显着下降到2021年的3.51%(p<0.001)。大多数病例表现为组织丢失(81.25。常见的术后并发症包括主要不良心脏事件(8.9%)和手术部位感染(3.6%)。16.8%的患者在1年时发生严重截肢。术后1年死亡率为10%。在2年未调整的Kaplan-Meier生存分析中,原发性通畅率为50.56%±3.6%,男性为63.49%±3.27%,无截肢生存率为71.71%±0.98%。在调整后的分析中[针对合并症进行了调整,指示,导管类型,紧迫性,先前的血管干预,移植物流入血管(股/pop),伴随的流入程序,除GSV(p<0.001)外,外科医生和中心容积]导管与原发性通畅性丧失和男性增加相关.高中心体积(>5次手术/年)与改善原发性通畅性相关(p=0.015),2岁时男性较低(p=0.021)。
结论:尽管利用率下降,开放手术旁路至踝关节远端目标仍然是IP-CLTI治疗的可行选择,在2年时具有可接受的通畅性和无截肢生存率.应在高容量中心绕过远端目标,以优化移植物的通畅性和肢体抢救,并最大程度地减少再干预。