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KMID : 0371320010600050558
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Journal of the Korean Surgical Society
2001 Volume.60 No. 5 p.558 ~ p.564
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Analysis of Graft Patency and Risk Factors Influencing Graft Failure in Femorofemoral Crossover Bypass
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Kil Won-Ho
Kim Dong-Ik
Lee Sun-Jung
Lee Byung-Boong
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Abstract
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Purpose: Femorofemoral crossover bypass is commonly employed to treat unilateral iliac artery occlusion in chronic limb ischemic patients. We retrospectively analysed the risk factors related to postoperative graft failure and primary patency.
Methods: We reviewed 33 iliac artery occlusion patients who visited Samsung Medical Center between March 1995 and July 2000 and underwent femorofemoral bypass surgery. 33 cases were employed 6 mm or 7 mm PTFE (polytetrafluoroethylene). The average age of the patients was 63.3 year-old, and all of them were male. The indication of surgery were claudication (19 cases, 57.6%), resting pain (9 cases, 27.3%), and lower limb ulceration or gangrene (5 cases, 15.2%) in preoperatively.
Results: The average ankle-brachial index (ABI) was 0.34 preoperatively and 0.837 postoperatively. Graft failure after 30 days (late graft failure) was found in 7 cases (21.3%). The primary patency rates were 80.1% for 1 year and 60.1% for 2 years. According to the cross table analysis of the risk factors, smoking, diabetes mellitus, cardiac status, distal run- off score, and cerebrovascular disease related with carotid stenosis showed significantly high rate graft failure. A univariate
analysis of risk factors showed that preoperative smoking, diabetes mellitus, hypertension, distal run-off score, cardiac status, and cerebrovascular diseases related with carotid stenosis were significantly related with primary patency. However, according to multivariate analysis, these risk factors did not show any significant relationship with primary patency, with the exception of the distal run-off score (p= 0.0018).
Conclusion: Continuous and close care of patients through postoperative long-term follow up would improve graft patency in patients with risk factors, such as diabetes mellitus, carotid stenosis, cardiac status, and smoking. Examination of the preopertive distal run off artery will predict the prognosis of the postoperative graft patency.
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KEYWORD
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Femorofemoral crossover bypass, Risk factor, Graft patency
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