INFRAINGUINAL RECONSTRUCTIONS - INFLUENCE OF SURGICAL EXPERIENCE ON OUTCOME

Objectives: To evaluate the influence of surgical experience and opera tion technique on the outcome of infrainguinal reconstructions. Design : A longitudinal observational study of patients undergoing reconstruc tions to the popliteal and crural arteries, Setting: A regional hospit al and an academic referral centre, Materials: 392 patients undergoing 442 reconstructions, 218 to the popliteal and 228 to the crural vesse ls. Chief outcome measures: Graft patency and leg salvage, Main result s: At the popliteal level, 5-year patency after autogenous vein recons truction was 76%. No difference was found between in situ and transpos ed vein reconstructions, but prosthetic reconstructions had a worse pa tency. At the crural level, 5-year patency for in situ vein, transpose d vein and prosthetic bypass were 66, 55 and 21%, respectively. Corres ponding leg salvage for chronic critical leg ischaemia was 91% with ve in and 55% with prosthetic reconstruction at popliteal level, and 66 a nd 33% at the crural level, Surgical experience improved the outcome, as 3-year patency for in situ and transposed vein bypasses to the popl iteal level were 82 and 95% for experienced surgeons, and 53 and 75% f or less experienced surgeons, Corresponding leg salvage rates for reco nstructions to the popliteal and crural levels were 85 and 67% for exp erienced surgeons, and 61 and 52% for less experienced surgeons. Concl usions: Outcome of infrainguinal reconstructions is influenced by the reconstruction level, Surgical experience and choice of the appropriat e reconstruction technique can improve outcome. (C) 1998 The Internati onal Society for Cardiovascular Surgeons, Published by Elsevier Scienc e Ltd. All rights reserved.