Graft Failure After Revascularization for Chronic Limb-Threatening Ischaemia (CLTI) Patients: The Role of Graft Surveillance

TL;DR

This study examines how graft surveillance affects outcomes in patients with severe leg artery disease, finding that surveillance helps prevent graft failure.

Contribution

The study evaluates adherence to vascular surgery guidelines and the impact of graft surveillance on preventing graft failure in CLTI patients.

Findings

61% of patients received graft surveillance, while 44% of unsupervised patients experienced graft occlusion.

Surveillance can identify at-risk grafts and prevent occlusion through timely intervention.

Most patients had femoro-popliteal bypasses, with 18% undergoing amputation and 15% dying during the study period.

Abstract

Introduction

Failure of infrainguinal bypass grafts remains a major problem tackled by vascular surgeons despite a meticulous surgical technique. All infrainguinal bypasses should go under routine surveillance to pick the grafts at risk for the prevention of graft failure.

Objectives

The aim was to find out if we were adhering to the European Society of Vascular Surgery (ESVS) guidelines in the management of chronic limb-threatening ischaemia (CLTI) patients, including postoperative follow-up and to monitor whether the patients were having postoperative duplex surveillance scans to pick any graft at risk.

Methods

All patients who underwent infra-inguinal bypass procedures for CLTI during the last eight months (from mid-January to mid-September 2023) in our vascular unit were included. Retrospective data were collected.

Results

A total of 38 patients had lower limb bypass procedures over the last eight months (from 15 January till 14 September 2023). However, two femoral-femoral (fem-fem) crossovers, one Ilio-popliteal, and one pedal bypass were excluded. Thus, a total of 36 patients were included in the study (n=34). The vast majority (n=27, 79.4%) had femoro popliteal bypass anastomosing distally to above knee (AK) or below knee (BK) popliteal artery, and the rest (n=7, 20.5%) had distal bypass (fem-distal or pop-distal bypass). Moreover, 18% of patients had amputation, 15% of patients died, and 61% of the remaining patients were on surveillance. Of those, who were not on surveillance, 44% of them had graft occlusion.

Conclusion

Surveillance can predict graft at risk, and the graft occlusion can be prevented by appropriate intervention. Every vascular unit should have its own post-procedural follow-up strategies.

Figures