The impact of a prior revascularization procedure on the outcome of a future lower limb bypass for chronic threatened limb ischemia

BacKgrouNd: It is frequent that bypasses performed for chronic threatened limb ischemia (ctlI) being preceded by revascularization procedures attributing a high risk for poor outcomes. In this study, we sought to evaluate the impact of a prior procedure upon the future of an ipsilateral infrainguinal bypass performed for ctlI. MEtHods: It was performed a retrospective study over a 4-year period in order to identify patients who underwent infrainguinal bypasses for ctlI. Primary endpoints were considered primary patency and amputation free survival, whereas secondary endpoints the survival rate, length of hospitalization and complications rate. RESULTS: We identified 148 bypasses performed for CTLI. Among these, 94 were primary bypasses, whereas 54 were preceded successfully by a revascularization procedure with endovascular approach in 29 limbs and open approach in 25 limbs. All patients had a follow-up of 24 months (range 24-60). Primary patency, amputation-free survival and survival rate at 1 year were respectively for primary bypasses 80.9%, 84%, 91.8%, prior Endo 72.5%, 65.5%, 89.6%, prior Open 72%, 60%, 84%. At 2 years the differences between groups were not significant. The median length of hospitalization was 5 days (range: 4-11 days) without significant differences between the two groups. Complication rate at the surgical site such as lymphorrhea and infection were respectively 20%, 5% in the open group and 4%, 0% in prior Endo group. coNclusIoNs: at 1-year bypasses preceded by an open procedure had a poorer outcome compared to those preceded by an endovascular one. However, at long term this difference was insignificant.