Predictors of outcome when reoperating for early infrainguinal bypass occlusion

The purpose of this study is to identify factors that predict outcome after intervention for early (<30 days) infrainguinal graft thrombosis. We revie wed the medical records, arteriograms, and follow-up studies of patients wh o underwent infrainguinal bypass for limb salvage between 8/91 and 9/98 and whose graft failed <30 days from the index procedure. Five factors were an alyzed: (1) conduit: single segment saphenous vein versus alternative vein or composite conduit (20 vs. 13 patients); (2) repair modality: constructio n of a new graft at the time of the initial take-back procedure versus loca l revision and/or thrombectomy alone (12 vs. 21 patients); (3) run-off: goo d run-off versus poor run-off (20 vs. 13 patients); (4) operative findings: the presence of a correctable problem versus noncorrectable problem (20 vs . 13 patients); and (5) surgical history: previous Versus no previous ipsil ateral bypass (16 vs. 17 patients). These variables are statistically signi ficant risk factors that can be used in combination to predict outcome. Unl ess a focal lesion clearly responsible for graft occlusion is found, comple te graft replacement should be considered even if the new bypass must be pr osthetic. The costs and morbidity of repeated procedures argue for primary amputation when adverse risk factors exist. DOI: 10.1007/s100169910080.