Temporal Trends in Infrainguinal Bypass Outcomes: A Comparative Analysis Across Three Eras

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

J Vasc Surg

Abstract

Objectives: The declining volume of infrainguinal bypass (IIB) has raised concerns over contemporary outcomes compared to earlier periods. This study compares the outcomes of IIB in the contemporary era to earlier periods when IIB was more widely practiced. Methods: Patients undergoing IIB for peripheral artery disease (PAD) between 2003-2021 were identified in the Vascular Quality Initiative (VQI). Patients were stratified into three groups based on treatment era: early era (2003-2007, E1), intermediate era (2009-2013, E2), and contemporary era (2015-2019, E3). Mantel-Haenszel (MH) test for linear trend was used to test for a linear relationship between era and outcomes. Multivariate Cox regression was used to evaluate the independent association of treatment era with the outcomes of primary patency, reoperation, major amputation, and mortality. Results: A total of 39,538 patients received IIB during this time period. The average number of IIB performed per center dropped from 47.8 IIB/year to 25.3 IIB/year between 2003-2020 (Fig 1). Patients in the latter period (E3) were more likely to have a previous ipsilateral infrainguinal peripheral vascular intervention (P <.001), ipsilateral minor amputation (P <.001), and undergo emergent surgery (P <.001). Over the three time periods, there was a significant decrease in venous conduit use (E1, 71.3%; E2, 60.8%; E3, 55.2%; P <.001). Worse outcomes at 1-year for primary patency (E1, 88.6%; E2, 86.1%; E3, 84.4%; P <.001) and higher rates of reintervention (E1, 12.4%; E2, 15.0%; E3, 15.8%; P =.002) and major amputation (E1, 9.4%; E2, 9.1%; E3, 10.4%; P =.009) were observed. On multivariate Cox- regression, compared to E1 patients, higher hazard of loss of primary patency was observed for both E2 (HR, 1.72; 95% CI, 1.51-1.95) and E3 (HR, 3.67; 95% CI, 3.23-4.17) patients (Table I). In addition, higher re-intervention was observed for both E2 (HR, 1.38; 95% CI, 1.17-1.62) and E3 (HR, 1.41; 95% CI, 1.21-1.66) patients. No difference was seen regarding major amputation and 30-day mortality between the three eras. Conclusions: There is a decline in the mean rate of IIB performed across the centers in the VQI. Patients undergoing IIB for lower extremity PAD in the contemporary era have decreased primary patency compared to those in earlier eras. This decline may stem from decreased technical proficiency associated with lower bypass volume, increased complexity of disease, and decreased use of vein conduits. This study emphasizes the need for further investigation into the factors contributing to the changing landscape of IIB outcomes. [Formula presented] [Formula presented]

Volume

79

Issue

6

First Page

e262-e263

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