Mid and long term follow-up results of patients who had infrainguinal by-pass surgery

BACKGROUND: Peripheral artery disease (PAD) is a chronic disease caused by atherosclerosis and mostly affects the lower extremity arteries. Surgical methods play an essential role in the treatment of PAH. This study aimed to investigate the mid- and long- term results of infrainguinal bypass surgery. METHODS: Seventy-seven patients who underwent isolated infrainguinal bypass surgery between January 2015 and January 2022 with the diagnosis of lower extremity PAD were retrospectively examined. Clinical characteristics and demographic data of the cases, preoperative and postoperative Rutherford categories, amputation, survival and graft-related complication (thrombosis and infection) rates were examined. Kaplan-Meier analysis was used for survival analyses. RESULTS: During the follow-up period (average seven years), overall mortality was 44.2%. It was observed that overall survival rates were lower in cases with chronic renal failure (p<0.05). There was a significant decrease (p <0.001) in the postoperative Rutherford clinical stages of the cases compared to their preoperative stages. It was determined that amputation occurred in 37.6% of the cases and graft-related complications occurred in 11.6%. It was determined that graft-related complication rates were lower in autogenous vein grafts than in prosthetic grafts (p<0.01). Amputation-free survival was found to be lower in insulin-dependent diabetes and hemodialysis-dependent chronic renal failure (p<0.02). It was observed that graft type had no effect on amputation-free survival, but major amputation-free survival was higher in cases where vein graft was used (p=0.02). CONCLUSION: We observed that infrainguinal bypass surgery provided a significant improvement in the clinical disease stage. It is noteworthy that the use of saphenous vein graft reduces graft-related complications and increases major amputation- free survival. Mortality, overall survival and amputation-free survival rates were significantly lower in patients with chronic renal failure.