Natural history of composite sequential bypass - Ten years' experience

Background: We previously reported 48-month patency rates of composite sequ ential bypass (CSB) approaching 60%. Yet, extended patency and limb salvage rates are unknown. Hypothesis: Long-term. patency and limb salvage rates of CSB are affected b y sex, bypass configuration, and warfarin therapy. Design: Medical records of all patients who underwent CSB during a 10-year period were retrospectively reviewed. Setting: A referral center for the Chicago, Ill, region. Patients: One hundred consecutive patients (mean age, 68.8 years; 57% were men and 49% had diabetes) undergoing 102 CSBs for limb salvage (ulcer, 43%; rest pain, 39%; and gangrene, 18%) from January 1986 to January 1996 were identified. Interventions:: Warfarin was used after surgery by 72% of patients and aspi rin was used by the remainder of them. Main Outcome Measures: Life table primary patency and limb salvage rates we re compared for sex, diabetes mellitus status, location of distal prostheti c anastomosis (above knee vs below knee), and anticoagulation drug therapy (warfarin sodium vs aspirin) with log-rank statistics. Results: Primary patency of CSB was 56% at 24 months, 29% at 48 months, and 20% at 84 months (SE<10%; mean follow-up, 19.6 months [range, 1.0-110.0 mo nths]). Limb salvage rates were 64% at 24 months, 30% at 48 months, and 23% at 84 months (SE<10%); 66% and 90% of patients had failed grafts requiring amputation by 3 months and I year, respectively. Conclusions: Composite sequential bypass for limb salvage provides reasonab le 2-year patency. However, patency rates steadily declined from year 2 to year 5. After CSB failure, limb salvage rates are poor, with 90% of patient s progressing to amputation within I year.