The impact of infrainguinal endovascular interventions on the results of subsequent femoro-tibial bypass procedures: A retrospective cohort study

Uhl, Christian; Hock, Carolin; Betz, Thomas; Bröckner, Stefan; Töpel, I.; Steinbauer, Markus

doi:10.1016/j.ijsu.2014.12.010

Cited by 15 publications

(17 citation statements)

References 13 publications

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“…Most recently, a European series demonstrated no differences in primary and secondary patency rates for 40 patients undergoing tibial and peroneal bypass after EVT compared with 93 primary below-knee bypasses. 20 These studies and others suggest the opposite of what the BASIL trial and the Vascular Study Group of New England study proposed. The reason for this divergent conclusion is unclear at this juncture.…”

Section: Discussionmentioning

confidence: 96%

Impact of femoropopliteal endovascular interventions on subsequent open bypass

Gifford

Fleming

Mendes

et al. 2016

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 96%

Impact of femoropopliteal endovascular interventions on subsequent open bypass

Gifford

Fleming

Mendes

et al. 2016

Journal of Vascular Surgery

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“…In comparison to primary bypass treatment, Uhl et al found no association between prior endovascular intervention and 30-day mortality, graft failure, or major amputation. 11 In addition, Santo el al. determined that prior endovascular intervention was not associated with 30-day mortality or myocardial infarction and was not a predictor for overall wound complication compared to primary bypass.…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcomes of infrainguinal bypass surgery in patients with and without prior revascularization

Bodewes

Ultee

Soden

et al. 2017

Journal of Vascular Surgery

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Objective Although an increasing number of patients with peripheral arterial disease undergo multiple revascularization procedures, the effect of prior interventions on outcomes remains unclear. The purpose of this study was to evaluate perioperative outcomes of bypass surgery in patients with and those without prior ipsilateral treatment. Methods Patients undergoing non-emergent infrainguinal bypass between 2011 and 2014 were identified in the NSQIP-Targeted Vascular module. After stratification by symptom status (chronic limb-threatening ischemia [CLTI] and claudication), patients undergoing primary bypass were compared to those undergoing secondary bypass. Within the secondary bypass group, further analysis compared prior bypass to prior endovascular intervention. Multivariable logistic regression analysis was used to establish the independent association between prior ipsilateral procedure and perioperative outcomes. Results A total of 7302 patients were identified, of which 4540 (62%) underwent primary bypass (68% for CLTI), 1536 (21%) underwent secondary bypass after a previous bypass (75% for CLTI), and 1226 (17%) underwent secondary bypass after a previous endovascular intervention (72% for CLTI). Prior revascularization on the same ipsilateral arteries was associated with increased 30-day major adverse limb event in patients with CLTI (9.8% vs. 7.4%; OR: 1.4, 95% CI: 1.1–1.7) and claudication (5.2% vs. 2.5%; 2.1, 1.3–3.5). Similarly, secondary bypass was an independent risk factor for 30-day major reintervention (CLTI: 1.4, 1.1–1.8; claudication: 2.1, 1.3–3.5), bleeding (CLTI: 1.4, 1.2–1.6; claudication: 1.7, 1.3–2.4), and unplanned reoperation (CLTI: 1.2, 1.0–1.4; claudication: 1.6, 1.1–2.1), whereas major amputation was increased in CLTI patients only (1.3, 1.0–1.8). Perioperative mortality was not significantly different in patients undergoing secondary compared to primary bypass (CLTI: 1.7% vs. 2.2%, P = .22; claudication: 0.4% vs. 0.6%, P = .76). Among secondary bypass patients with CLTI, those with prior bypass had higher 30-day reintervention rates (7.8% vs. 4.9%; OR: 1.5, 95% CI: 1.0–2.2), but fewer wound infections (7.3% vs. 12%; 0.6, 0.4–0.8) compared to patients with prior endovascular intervention. Conclusions Prior revascularization, in both patients with CLTI and claudication, is associated with worse perioperative outcomes compared to primary bypass. Furthermore, prior endovascular intervention is associated with increased wound infections, whereas those with prior bypass had higher reintervention rates. The increasing prevalence of patients undergoing multiple interventions stresses the importance of patient selection for initial treatment and should be factored into subsequent revascularization options in an effort to decrease adverse events.

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“…After excluding duplicates and applying the inclusion criteria, a total of six studies were retained. All of the included studies were retrospective clinical trials (22)(23)(24)(37)(38)(39).…”

Section: Resultsmentioning

confidence: 99%

“…surgery following a failed stenting operation, compared with patients receiving bypass surgery without prior history of endovascular intervention. However, Uhl et al (24) reported a higher mortality rate in patients receiving bypass surgeries with no prior history of endovascular intervention. To the best of our knowledge, no previous systematic reviews or meta-analyses have evaluated morbidity and mortality-related factors in patients with peripheral arterial disease of the lower extremities undergoing bypass surgeries.…”

Section: Impact Of Prior Endovascular Interventions On Outcomes Of Lomentioning

confidence: 99%

Impact of prior endovascular interventions on outcomes of lower limb bypass surgery: A systematic review and meta‑analysis

Hai

Guan

et al. 2020

Exp Ther Med

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The aim of this meta-analysis was to evaluate the mortality, amputation and complication rates in patients with peripheral lower limb arterial disease undergoing bypass surgery with or without a prior history of endovascular operation. A systematic literature screen was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on four academic databases, Medline, Scopus, Embase and Cochrane Central Register of Controlled Trials. Out of 1,072 records, six articles involving 11,420 patients (mean age, 68.1±2.0 years) met the inclusion criteria. The findings presented a 2b level of evidence (i.e. overall evidence represents data from individual cohort study or low quality randomized controlled trials) and suggested lower mortality, amputation and complication rates for patients undergoing bypass surgery without any history of endovascular operation, compared with those with a history of prior endovascular operation. Moreover, a random-effect meta-analysis suggested a small, positive reduction in mortality (Hedge's g=0.08), amputation (Hedge's g=0.18) and complication rates (Hedge's g=0.05) for patients undergoing bypass surgery without any history of endovascular operation. Nevertheless, owing to the scarcity of high-quality data, further studies and randomized clinical trials are needed to confirm these effects.

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The impact of infrainguinal endovascular interventions on the results of subsequent femoro-tibial bypass procedures: A retrospective cohort study

Abstract: Prior endovascular intervention of femoro-tibial vessels does not have a negative impact on the outcome of subsequent tibial or peroneal bypass surgery in patients with critical limb ischemia.

Cited by 15 publications

References 13 publications

Impact of femoropopliteal endovascular interventions on subsequent open bypass

Impact of femoropopliteal endovascular interventions on subsequent open bypass

Perioperative outcomes of infrainguinal bypass surgery in patients with and without prior revascularization

Impact of prior endovascular interventions on outcomes of lower limb bypass surgery: A systematic review and meta‑analysis

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