Infrainguinal revascularisation in the era of vein-graft surveillance - Doclinical factors influence long-term outcome?

Objectives: to investigate the variables affecting the long-term outcome of infrainguinal vein bypass grafts that have undergone postoperative surveil lance. Design: a retrospective analysis. Patients and methods: details of 299 consecutive infrainguinal vein grafts performed in 275 patients from a single university hospital were collected and analysed. All grafts underwent postoperative duplex surveillance. Facto rs affecting patency, limb salvage and survival rates were examined. These factors were gender, diabetes, hypertension, aspirin, warfarin, ischaemic h eart disease, run-off graft type, early thrombectomy, level of anastomoses and indication for surgery. Results: the 6-year primary, primary assisted and secondary patency rates w ere 23, 47, and 57%, respectively. Six-year limb salvage and patient surviv al were 68 and 45%, respectively Primary patency was adversely influenced b y the use of composite vein grafts. Early thrombectomy was the only factor that significantly influenced secondary patency. Limb salvage was worse in diabetic limbs, limbs with poor run-off and in grafts that required early t hrombectomy. Postoperative survival was better in males, claudicants and in patients who took aspirin. Conclusions: although co-morbid factors did not influence graft patency rat es, diabetes did adversely effect limb salvage. This study, like others bef ore it, confirms that aspirin significantly reduces long-term mortality in patients undergoing infrainguinal revascularisation.