Abstract
Objectives
To investigate the association of the intraoperative flow waveform and the flow volume
with the graft prognosis of infrainguinal vein bypass.
Design
Retrospective study.
Methods
Intraoperative flowmetry was performed for infrainguinal autologous vein bypass between
2011 and 2020. Flow waveforms were classified into type 0-IV according to the Kyushu
University (KU) classification. The patients (n=340) were divided into three groups
based on the flow waveform predicting the graft patency: type 0/I (long patency),
type II (no early occlusion but late occlusion possible) and type III/IV (early occlusion).
The graft occlusion rates of popliteal artery bypass (PAB) and infrapopliteal artery
bypass (IPAB) within 30 days after surgery were compared between type 0/I+II and type
III/IV groups, while the mid-term graft patency rates were compared between type 0/I
and type II groups. Additionally, a multivariate analysis was performed to identify
independent risk factors for early and late graft occlusion.
Results
The early graft occlusion rates of type 0/I+II and type III/IV groups were 3.9 % and
0%, respectively, (p=1.00) for PAB and 5.3 % and 46.2% respectively, (p<.001) for IPAB. The 2 years’ primary patency rates of type 0/I and type II groups
were 91% and 75%, respectively, (p= .030) for PAB and 58% and 63%, respectively, (p= .72) for IPAB. An independent risk factor for early occlusion was none in PAB and flow
waveform (type IV) in IPAB. An independent risk factor in PAB was flow waveform (type
II), end-stage renal disease, and dual antiplatelet use and those in IPAB were older
age, female sex, lower flow volume, and iterative bypass for primary patency loss.
Conclusions
Intraoperative flowmetry is useful for predicting the graft prognosis in infrainguinal
vein bypass and its significance depends on the distal target artery.
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Article info
Publication history
Accepted:
December 23,
2022
Received in revised form:
November 14,
2022
Received:
February 20,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
