A. Zil-E-Ali1, T.Z. Ali1, A. Safaya1, F. Aziz1 1Penn State Milton S. Hershey Medical Center, Vascular Surgery, Hershey, PA, USA
Introduction: Reintervention after a lower extremity bypass in patients with chronic limb-threatening ischemia (CLTI) is a significant complication associated with readmission and increased healthcare costs. This study aims to assess the burden of reintervention on the treated arterial segment and evaluate the associated risk factors.
Methods: This study analyzed patients undergoing lower extremity bypass surgery for CLTI using data from the National Surgical Quality Improvement Program (NSQIP) from 2013 to 2021. The cohort was stratified into two groups based on the occurrence of major reintervention on the bypass (MRB) within 30 days postoperatively. Patients requiring popliteal distal bypass were excluded. Group I comprised patients who underwent MRB, while Group II included those who did not experience MRB. MRB is defined as a surgical or endovascular intervention performed to treat graft failure, occlusion or other complications. Multivariate analyses were performed to identify the risk factors associated with MRB.
Results:A total of 13,908 patients were included in the study, of whom 764 (5.5%) underwent MRB. Patients with rest pain had a higher risk of MRB compared to those treated for tissue loss or gangrene (6.1% vs. 5%, p=0.002). Multivariate analysis identified several factors associated with MRB, including female sex (aOR: 1.35 [1.15 – 1.59], p<0.001), undergoing an emergent bypass (aOR: 1.61 [1.25 – 2.16], p<0.001), and receiving a femoral distal bypass with prosthetic, spliced, or composite vein (aOR: 1.31 [1.05 – 1.63], p=0.015). Conversely, patients with normal BMI and those undergoing femoral to popliteal bypass with a single vein segment had the lowest likelihood of MRB.
Conclusion:This study underscores the significant burden of major reintervention (MRB) following lower extremity bypass surgery in patients with chronic limb-threatening ischemia (CLTI). Identifying risk factors, including the site of bypass based on the arterial segments involved and the type of graft used, can facilitate better risk stratification. These insights can inform clinical decisions and optimize patient outcomes by targeting high-risk individuals for closer monitoring and tailored interventions.