Defining utility and predicting outcome of cadaveric lower extremity bypass grafts in patients with critical limb ischemia Catherine K. Chang, MD, Salvatore.

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Presentation transcript:

Defining utility and predicting outcome of cadaveric lower extremity bypass grafts in patients with critical limb ischemia Catherine K. Chang, MD, Salvatore T. Scali, MD, Robert J. Feezor, MD, Adam W. Beck, MD, Alyson L. Waterman, MD, MPH, Thomas S. Huber, MD, PhD, Scott A. Berceli, MD, PhD Journal of Vascular Surgery Volume 60, Issue 6, Pages 1554-1564 (December 2014) DOI: 10.1016/j.jvs.2014.06.009 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 This Kaplan-Meier curve depicts the overall survival for patients receiving cadaveric vein bypass for a critical limb ischemia (CLI) indication. Actuarial estimated survival at 1 and 3 years is 84% (95% confidence interval [CI], 74-90) and 62% (95% CI, 49-72), respectively. All displayed time intervals have <10% standard error of the mean. Journal of Vascular Surgery 2014 60, 1554-1564DOI: (10.1016/j.jvs.2014.06.009) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Primary patency of cadaveric vein bypass in critical limb ischemia (CLI) patients was 27% (95% confidence interval [CI], 16-39) and 17% (95% CI, 7-30) at 1 and 3 years, respectively. B, The primary-assisted patency after cadaveric vein bypass for a CLI indication was not significantly different from the primary patency despite that a majority of patients underwent routine postoperative duplex ultrasound surveillance and had a reintervention threshold of a peak systolic velocity step-up of 3.5× or drop in ankle brachial index ≥0.15. All displayed time intervals have <10% standard error of the mean. Journal of Vascular Surgery 2014 60, 1554-1564DOI: (10.1016/j.jvs.2014.06.009) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Amputation-free survival (AFS) was significantly different (log-rank, P = .04) between patients undergoing cadaveric vein bypass for a rest pain indication and subjects with tissue loss. All displayed time intervals have <10% standard error of the mean. Journal of Vascular Surgery 2014 60, 1554-1564DOI: (10.1016/j.jvs.2014.06.009) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 A, Freedom from major (above the ankle) amputation in all critical limb ischemia (CLI) patients is demonstrated on this graph. B, Similar to amputation-free survival (AFS), freedom from major amputation was significantly different (log-rank, P = .01) between rest pain and tissue loss patients. Notably, a significant proportion of patients in the rest pain group underwent concomitant femoral arterial or iliac inflow reconstruction at the time of their cadaveric vein bypass, which likely contributed to these findings. All displayed time intervals have <10% standard error of the mean. Journal of Vascular Surgery 2014 60, 1554-1564DOI: (10.1016/j.jvs.2014.06.009) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 5 A, Overall, estimated freedom from major adverse limb events (MALEs) after cadaveric vein bypass for a critical limb ischemia (CLI) indication was 47% (95% confidence interval [CI], 28-53) and 25% (95% CI, 12-39) at 1 and 3 years, respectively. B, Not surprisingly, primarily owing to significant differences in rates of major amputation after cadaveric vein bypass revascularization, significant differences in freedom from MALEs exist between rest pain and tissue loss patients (P = .004). All displayed time intervals have <10% standard error of the mean. Journal of Vascular Surgery 2014 60, 1554-1564DOI: (10.1016/j.jvs.2014.06.009) Copyright © 2014 Society for Vascular Surgery Terms and Conditions