Infrainguinal Bypass Surgery Shows High Perioperative Morbidity

A new study exhorts that stringent indications for infrainguinal bypass surgeries (BPG) should be maintained, and when clinically and anatomically feasible, endovascular procedures should be considered as the initial therapy for infrainguinal arterial reconstruction.

Researchers at Massachusetts General Hospital (Boston, USA) collected data from the U.S. National Surgical Quality Improvement Program, which provided statistics for 2,404 BPGs (infrapopliteal distal anastomosis 42%, prosthetic 29%), derived from multiple private sector hospitals around the United States. Patients ranged from 66 to 69 years and 66% were male; 48% had diabetes and the indication for surgery was limb salvage in 48%.

The researchers found that overall mortality was 2.7% and correlated with patient age, weight, significant dyspnea, dialysis, history of transient ischemic attack (TIA), and bleeding disorders. Major complications of BPG occurred in 18.7% of the patients including 7.4 % graft thromboses and 11.7% wound infections. Major systemic complications occurred in 5.9% and correlated to age, history of myocardial infarction (MI), dialysis, impaired sensorium, and general anesthesia. Major operative site-related complications occurred in 15.1% and correlated to a history of chronic obstructive pulmonary disease (COPD), limb salvage, impaired sensorium, non-independent preoperative functional status, and operative time. The study was presented at the Society for Vascular Surgery (SVS) Vascular annual meeting, held during June 2008 in San Diego (CA, USA).

"Our study shows that infrainguinal BPG carries with it a non-trivial complication rate which we need to fully appreciate,” said lead author Glenn LaMuraglia, M.D., an associate professor of surgery. "The results of this study, which delineates the systemic and the local surgical complications, should assist us in taking better care of our patients with lower extremity ischemia.”

According to Dr. LaMuraglia, the decision to use BPG or endovascular procedures to treat lower extremity vascular disease is partly dependent on periprocedural outcomes. Endovascular procedures, such as percutaneous transluminal angioplasty should be considered as the initial therapy for infrainguinal arterial reconstruction because they have been previously reported to carry lower complication rates.


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