Objective: Aim is to demonstrate contemporary outcomes of in situ saphenous vein bypass with the use of a new valvulotome in the framework of a national, multicenter registry based on the treatment of critical Limb IscheMia with infragenicular Bypass adopting in situ SAphenous VEin technique (LIMBSAVE). Methods: Between January 2018 and December 2019 541 patients in 43 centers have been enrolled. In all patients a HYDRO LeMa LeMaître valvulotome (LeMa LeMaître Vascular, Burlington, MA) was used. Early outcomes were assessed. Two-year outcomes according to Kaplan-Meier curves in terms of patencies, and limb salvage were evaluated. Associations of patient and procedure variables were analyzed with univariate and multivariate analyses. Results: In all cases valvulotome was able to lyse the valves. Vein injuries due to the in situ technique was 3.5%. Thirty-day mortality and major amputation rates were 3 and 0.9%, respectively. Mean follow-up was 12.1 months. Two-year estimated primary patency, primary assisted patency, secondary patency, and limb salvage were 69.1, 81.4, 86.5, and 94.5%, respectively ([Fig.]). Multivariate analysis showed association of preoperative vein diameter <3 mm with lower primary patency (HR 14.3, p <0.001), primary assisted patency (HR 9.4, p = 0.002), secondary patency (HR 7.2, p = 0.007), and limb salvage (HR 7.8, p = 0.005) rates. Distal anastomosis on a tibial/foot vessel also had association with lower primary patency (HR 4.8, p = 0.03), and primary assisted patency (HR 6, p = 0.01) rates. Use of a suprafascial tributary collateral as graft confirmed association with lower primary patency (HR 6.7, p = 0.01), and primary-assisted patency (HR 4.2, p = 0.04) rates. Conclusion: Vein diameter <3 mm, distal anastomosis on a tibial/foot vessel, and use of a suprafascial tributary collateral as graft strongly affected 2-year patency and limb salvage of in situ saphenous vein bypass.

Factors Affecting Patency of In Situ Saphenous Vein Bypass: 2-Year Results from LIMBSAVE (Treatment of Critical Limb Ischemia with Infragenicular Bypass Adopting In situ Saphenous Vein Technique) Registry

Troisi, Nicola
Primo
Writing – Original Draft Preparation
;
Berchiolli, Raffaella
Ultimo
Writing – Review & Editing
2022-01-01

Abstract

Objective: Aim is to demonstrate contemporary outcomes of in situ saphenous vein bypass with the use of a new valvulotome in the framework of a national, multicenter registry based on the treatment of critical Limb IscheMia with infragenicular Bypass adopting in situ SAphenous VEin technique (LIMBSAVE). Methods: Between January 2018 and December 2019 541 patients in 43 centers have been enrolled. In all patients a HYDRO LeMa LeMaître valvulotome (LeMa LeMaître Vascular, Burlington, MA) was used. Early outcomes were assessed. Two-year outcomes according to Kaplan-Meier curves in terms of patencies, and limb salvage were evaluated. Associations of patient and procedure variables were analyzed with univariate and multivariate analyses. Results: In all cases valvulotome was able to lyse the valves. Vein injuries due to the in situ technique was 3.5%. Thirty-day mortality and major amputation rates were 3 and 0.9%, respectively. Mean follow-up was 12.1 months. Two-year estimated primary patency, primary assisted patency, secondary patency, and limb salvage were 69.1, 81.4, 86.5, and 94.5%, respectively ([Fig.]). Multivariate analysis showed association of preoperative vein diameter <3 mm with lower primary patency (HR 14.3, p <0.001), primary assisted patency (HR 9.4, p = 0.002), secondary patency (HR 7.2, p = 0.007), and limb salvage (HR 7.8, p = 0.005) rates. Distal anastomosis on a tibial/foot vessel also had association with lower primary patency (HR 4.8, p = 0.03), and primary assisted patency (HR 6, p = 0.01) rates. Use of a suprafascial tributary collateral as graft confirmed association with lower primary patency (HR 6.7, p = 0.01), and primary-assisted patency (HR 4.2, p = 0.04) rates. Conclusion: Vein diameter <3 mm, distal anastomosis on a tibial/foot vessel, and use of a suprafascial tributary collateral as graft strongly affected 2-year patency and limb salvage of in situ saphenous vein bypass.
https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0042-1750936
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1150522
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