S. S. Patel1, Y. Kim1, C. Decarlo1, S. Lee1, A. Dua1 1Massachusetts General Hospital, Vascular Surgery, Boston, MA, USA
Introduction: Intermittent claudication (IC) is characterized by exertional pain without limb-threatening ischemia. While historical rates of limb loss for IC are low, patients are still offered intervention for symptomatic improvement. Femoropopliteal bypass surgery is reserved for treatment of IC that has failed maximal medical management. The long-term risks and consequences of femoropopliteal bypass surgery for IC remain unclear.
Methods: The Research Patient Data Registry database was retrospectively queried for femoropopliteal bypass procedures using CPT codes. Electronic medical records were used to obtain demographic information, operative details, postoperative complications, and long-term outcomes. The study period was 25 years (1995-2020) with a median follow-up period of two years.
Results: During the study period, a total of 1421 patients underwent femoropopliteal bypass surgery, of which 282 (19.8%) were performed for IC. Median age of IC patients undergoing bypass was 68 (interquartile range [IQR] 61-73). The majority of IC patients were male (69.5%) and Caucasian (87.9%). Femoropopliteal bypass conduits included great saphenous vein (GSV) (n=136, 48.2%), prosthetic grafts (n=138, 48.9%), and non-GSV autogenous grafts (n=8, 2.8%). Distal bypass target was above-knee in 175 (62.1%) and below-knee in 107 (37.9%) patients. Concurrent procedures during bypass included femoral endarterectomy (n=100, 35.4%) and endovascular intervention (n=36, 12.8%). Median hospital length of stay was 4 days (IQR 3-5 days) after bypass. Postoperative complication rates were notable for wound infection (n=40, 14.2%), hematoma or pseudoaneurysm (n=6, 2.2%), graft infection (n=7, 2.5%), lymphocele/lymphorrhea (n=4, 1.1%), and myocardial infarction (n=3, 1.1%). Thirty-day readmission rate was 12.4% (n=35). Mortality rates were 0.4% (n=1) at 30-days and 3.2% (n=9) after one year. Primary patency rates were highest for patients undergoing AK bypass with GSV conduit (AK/GSV, 73.0%; AK/prosthetic, 66.3%; BK/GSV, 64.5%; BK/prosthetic, 51.2%) (p<0.01).
Conclusion: Femoropopliteal bypass for intermittent claudication is associated with high rates of wound infection and thirty-day readmission. Patients undergoing bypass surgery should be educated on these risks, as well as rates graft patency and amputation-free survival prior to undergoing surgical intervention.
