Predictors of Long-Term Complications of Femoropopliteal Bypass with Autovenous Graft

INTRODUCTION: Atherosclerotic lesion of lower limb arteries often occurs with the development of chronic and later with critical ischemia of the lower limbs. Revascularization in these conditions has always been at the center of attention of vascular surgeons worldwide.

AIM: To analyze long-term complications after femoropopliteal bypass (FPB) with the autovenous graft.

MATERIALS AND METHODS: This retrospective open study was conducted in Scientific the Research Institute — Regional Clinical Hospital No. 1 named after Professor S. V. Ochapovsky (Krasnodar) in the period from January 10, 2016, to December 25, 2019, and included 464 patients who underwent FPB with venous autograft. The following autovenous conduits were used: n = 266, reverse vein (great saphenous vein (GSV)); n = 59, autovein (GSV) prepared in situ; n = 66, autovein (GSV) prepared ex situ; and n = 73, veins of an upper limb. The long-term follow-up period was 16.6 ± 10.3 months.

RESULTS: During the postoperative hospital period, single cases of lethal outcome and myocardial infarction were noted. No ischemic strokes were recorded. Shunt thrombosis developed in 4.5% of the patients, and 2.1% required limb amputation. Postoperative wound revision caused by bleeding was performed in 1.7% of the cases. In the remote follow-up period, adverse cardiovascular events were noted in every fifth patient (21.8%). Shunt thrombosis was diagnosed in 17.4% of cases, and limb amputation was performed in 5.1% of the cases. To identify the factors for poor prognosis, the whole sample was divided to two groups: group 1 (n = 366) included those without long-term complications and group 2 (n = 99) comprised patients with long-term complications. Using the odds ratio (OR), the following predictors of adverse cardiovascular events were identified: degree I obesity (р < 0.0001; OR = 3.24; 95% confidence interval (CI) = 1.93–5.43), degree II obesity (р = 0.0005; ОR = 4.84; 95% CI = 1.71–13.67), and stage IIB chronic lower limb ischemia (CLLI) (р = 0.0006; ОR = 2.24; 95% CI = 1.42–3.52). Protective factors were postinfarction cardiosclerosis (р = 0.04; ОR = 0.51; 95% CI = 0.27–0.95), excessive body mass (р = 0.01; ОR = 0.56; 95% CI = 0.35–0.88), and stage IV CLLI (р = 0.01; ОR = 0.53; 95% CI = 0.32–0.86).

CONCLUSIONS: FPB with venous autograft is characterized by a low frequency of complications in the hospital and long-term follow-up periods, making this technique a method of choice for the open surgical treatment of patients with extended atherosclerotic lesion of the superficial femoral artery. Predictors of adverse cardiovascular events in the long-term period are degree I obesity, degree II obesity, and stage IIB CLLI. Protective factors against the development of long-term surgical complications are postinfarction cardiosclerosis, overweight, and stage IV CLLI. The presented results should be considered when constructing stratification risk scales for adverse cardiovascular events in patients who underwent FPB. Precision management of patients with identified predictors of complications will allow the reduction of the risks for the development of these conditions and increase long-term survival free from shunt thrombosis and limb amputation.