Infrainguinal Bypass Surgery: High Perioperative Morbidity

Newswise — A number of clinical and anatomic factors influence the decision between infrainguinal bypass surgeries (BPG) and endovascular procedures used to treat lower extremity vascular disease, according to a new database and early outcomes study presented at the Vascular Annual Meeting, June 5-8, in San Diego, Calif. The data from the National Surgical Quality Improvement Program, which provided statistics for 2,404 BPGs (infrapopliteal distal anastomosis 42 percent, prosthetic 29 percent), was performed from a detailed major morbidity and mortality database derived from multiple private sector hospitals around the country. Study researchers at Massachusetts General Hospital in Boston, reinforced the precept that stringent indications for BPG should be maintained, and when clinically and anatomically feasible, endovascular procedures (percutaneous transluminal angioplasty) should be considered as the initial therapy for infrainguinal arterial reconstruction because they have been previously reported to carry lower complication rates. According to Glenn LaMuraglia, MD, associate professor of surgery, Harvard Medical School and Massachusetts General, the decision to use BPG and endovascular procedures to treat lower extremity vascular disease is partly dependent on periprocedural outcomes. These results help place the morbidity of lower extremity bypass surgery in the proper perspective.

In the current study, patients ranged from 66 to 69 years and 66 percent were male. Forty-four percent had diabetes and the indication for surgery was limb salvage in 48 percent. The 30-day composite mortality/major morbidity was 19.5 percent. The overall mortality was 2.7 percent and correlated with patient age, weight, significant dyspnea, dialysis, history TIA and bleeding disorders. Major complications occurred in 18.7 percent of the patients including 7.4 percent graft thromboses and 11.7 percent wound infections. Major systemic complications occurred in 5.9 percent and correlated to age, history MI, dialysis, impaired sensorium and general anesthesia. Major operative site-related complications occurred in 15.1 percent and correlated to a history chronic obstructive pulmonary disease, limb salvage, impaired sensorium, nonindependent preoperative functional status and operative time.

"Our study shows that infrainguinal BPG carries with it a non-trivial complication rate which we need to fully appreciate." said Dr. LaMuraglia. "The results of this study, which delineates the systemic and the local surgical complications, should assist us in taking better care of our patients with lower extremity ischemia."

About the Society for Vascular SurgeryThe Society for Vascular Surgery (SVS) is a not-for-profit society that seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness. SVS is the national advocate for 2,400 vascular surgeons dedicated to the prevention and cure of vascular disease. Visit the website at http://www.VascularWeb.org.