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Distal Revascularization: A 25 Year Experience

R Clement Darling, III, Sean P. Roddy, Manish Mehta, Paul B. Kreienberg, Benjamin B. Chang, Philip SK Paty, Kathleen J. Ozsvath, Yaron Sternbach, Dhiraj M. Shah.
Albany Medical College, Albany, NY.

OBJECTIVES: Infrainguinal reconstruction has undergone a series of evolutionary phases. In this report, we outline our 25-year experience of 9048 infrainguinal and infrageniculate arterial reconstructions.

METHODS: From 1981 to 2006 our group has performed 9048 arterial reconstructions. Indications for bypass include limb salvage in 7403 (82%). The in-situ technique was used in 4407 procedures, excised vein in 1935, spliced vein in 827, and 1879 procedures had prosthetic conduit. Patient demographics included coronary artery disease (64%), diabetes (49%), and smoking (34%). From the inception of the in-situ technique in the early 80’s we have gone from 95% in-situ reconstructions to currently <40% having available ipsilateral vein for in-situ bypass.

RESULTS: Operative mortality was 3.2% for all patients. One, five and 10-year secondary patency was 91%, 82%, 71% for in-situ, 85%, 72%, 62% for excised vein, 78%, 54%, 33% for prosthetic, and 65%, 46%, 31% for spliced vein. Limb salvage rates were 96%, 91%, 88% and 85% at 5 years for all groups respectively

CONCLUSIONS: Over the past 25 years, infrainguinal reconstruction has demonstrated excellent patency and limb salvage despite declining availability of autogenous vein for in-situ reconstruction. Venous conduit remains the gold standard for long term durability in infrainguinal and infrageniculate reconstruction.