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- W2040619725 abstract "The purpose of this study was to determine the outcome of endovascular interventions of the native circulation after failed lower extremity bypass grafting. A prospective registry encompassing all patients treated for lower extremity atherosclerotic disease from May 2004 to September 2008 was established. Patients were followed with duplex ultrasound and ankle-brachial index/pulse volume recording (ABI/PVR) at one, three, six, and 12 months and annually. Patients treated after failed lower extremity bypass grafting were identified and angiogram, duplex, and ABI data abstracted. Patients with similar comorbidities and lesion characteristics not treated with prior bypass grafting were used as comparison. Statistical analysis was performed using Kaplan-Meier and log-rank analysis. One thousand nine hundred and thirty eight lower extremity arterial lesions were treated in 826 patients. Seventy-four arterial lesions in 39 patients were treated in those who had undergone prior bypass grafting (BPG). Indications were claudication (n = 16, 38.5%), rest pain (n = 8, 17.9%), and tissue loss (n = 15, 43.6%). Prior bypass were femoral to popliteal (71.8%), femoral to tibial (25.6%), and external iliac to popliteal (2.6%). Mean follow-up was 13.7 ± 11.5 months. Comparison to a corresponding group of non-bypass graft patients (NBPG) revealed that there was no significant difference in primary, assisted primary, secondary patencies, or limb salvage in patients treated with prior BPG (Table I) when the indication for treatment was critical limb ischemia (CLI). In contrast, comparison to a corresponding group of NBPG revealed that there was significant decrease in primary, assisted primary, and secondary patency in patients treated with prior BPG (Table II) when the indication for treatment was claudication. This difference persisted even when corrected for comorbidities and lesion characteristics. Lesion length, percent stenosis, and percent chronic total occlusion were 162.7 ± 139.7 and 130.3 ± 56.9 (P = .21), 88.4 ± 11.0 and 90.1 ± 12.1 (P = .47), 34.4% and 49.7% (P = .12) for BPG and NBPG lesions, respectively.Table IPatency and limb salvage rates in CLI patients treated with endovascular modalities6 mo12 mo18 mo24 mo30 moPrimary patency BPG74.6 ± 7.351.2 ± 8.933.4 ± 9.333.4 ± 9.311.1 ± 9.6Primary patency No BPG69.2 ± 3.7P = .5951.0 ± 4.4P = .9542.1 ± 4.6P = .6835.2 ± 4.8P = .86035.2 ± 4.8P = .556Primary assisted patency BPG83.2 ± 6.358.8 ± 9.049.3 ± 9.849.3 ± 9.849.3 ± 9.8Primary assisted patency No BPG73.0 ± 3.6P = .2660.3 ± 4.3P = .9053.1 ± 4.7P = .9845.6 ± 5.1P = .7843.7 ± 5.2P = .74Secondary patency BPG83.1 ± 6.372.0 ± 8.161.3 ± 9.861.3 ± 9.861.3 ± 9.8Secondary patency No BPG78.2 ± 3.3P = .5771.7 ± 3.9P = .8864.5 ± 4.5P = .9557.9 ± 5.1P = .8655.9 ± 5.3P = .82Limb salvage BPG85.4 ± 6.076.9 ± 7.976.9 ± 7.976.9 ± 7.976.9 ± 7.9Limb salvage No BPG86.1 ± 2.8P = .8980.2 ± 3.5P = .7577.6 ± 3.9P = .8875.4 ± 4.4P = .9471.9 ± 5.4P = .98BPG, Bypass grafting; CLI, critical limb ischemia. Open table in a new tab Table IIPatency rates in claudicant patients treated with endovascular modality6 mos12 mos18 mos24 mos30 mosPrimary patency BPG65.6 ± 8.451.6 ± 9.125.8 ± 8.322.1 ± 7.922.1 ± 7.9Primary patency No BPG93.7 ± 2.275.4 ± 4.364.7 ± 4.960.2 ± 5.258.1 ± 5.5Primary patency P Values.0001.0001.0001.0001.0001Primary assisted patency BPG87.3 ± 6.075.9 ± 8.070.5 ± 9.165.1 ± 9.965.1 ± 9.9Primary assisted patency No BPG96.8 ± 1.690.9 ± 2.887.1 ± 3.483.8 ± 4.079.5 ± 4.8Primary assisted patency P Values.031.025.031.023.039Secondary patency BPG90.4 ± 5.390.4 ± 5.383.9 ± 7.977.5 ± 9.677.5 ± 9.6Secondary patency No BPG98.4 ± 1.196.4 ± 1.894.8 ± 2.491.3 ± 3.391.3 ± 3.3Secondary patency P values.03.13.06.05.05BPG, Bypass grafting. Open table in a new tab BPG, Bypass grafting; CLI, critical limb ischemia. BPG, Bypass grafting. Endovascular salvage of native arterial occlusions after failed surgical bypass achieves acceptable patency and limb salvage in patients with CLI. Conversely, patients with claudication that are subsequently treated with endovascular methods have poor long-term patency and require multiple endovascular interventions to maintain patency." @default.
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- W2040619725 date "2009-10-01" @default.
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- W2040619725 title "Salvage after Failed Surgical Bypass: Effectiveness of Endovascular Recanalization of Native Lower Extremity Arterial Occlusions" @default.
- W2040619725 doi "https://doi.org/10.1016/j.jvs.2009.07.031" @default.
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