Outcomes after open infrainguinal bypass in patients with scleroderma

Isibor Arhuidese, Mahmoud Malas, Tammam Obeid, Karen Massada, Alaa Khaled, Anas Alzahrani, Georges Samaha, Thomas Reifsnyder

Research output: Contribution to journalArticle

Abstract

Background: There are limited reports of outcomes after infrainguinal bypass surgery in patients with scleroderma. This study evaluated the long-term outcome after lower extremity bypass in these patients. Methods: The study included all patients with systemic sclerosis who underwent infrainguinal bypass surgery for severe peripheral arterial disease at our institution from January 1, 2007, to August 31, 2014. Kaplan-Meier and Cox regression analyses were used to evaluate graft failure and limb salvage. These outcomes were compared with those of nonscleroderma patients who underwent infrainguinal bypass surgery during the same period. Outcomes were defined and evaluated by Society for Vascular Surgery standards. Results: There were 18 autogenous grafts (6% femoral-popliteal, 11% femoral-tibial, 72% popliteal-tibial, 11% tibial-tibial) placed in 18 limbs from 12 patients with systemic sclerosis. Mean ± standard deviation age was 71 ± 9.5 years, and most of the patients were women (83%) and white (78%). All patients presented with critical limb ischemia. History of hypertension and coronary artery disease were 94% and 61%, respectively. All grafts used were autogenous, continuous, and harvested from the lower extremity (nonreversed great saphenous in 61% and reversed great saphenous in 39%). Mean follow-up duration was 2.3 ± 1.6 years. Graft failure was significantly higher in scleroderma patients than in nonscleroderma patients who underwent bypass in the same study period (hazard ratio, 7.2; 95% confidence interval, 1.44-41.4; P = .02). The limb salvage rate was 72%. Conclusions: Long-term outcomes after open infrainguinal bypass surgery in scleroderma patients are significantly worse than those in nonscleroderma patients. Careful consideration of their inherently poor outcomes should be made when reaching a decision for revascularization.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Aug 5 2015

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Transplants
Limb Salvage
Systemic Scleroderma
Thigh
Lower Extremity
Extremities
Peripheral Arterial Disease
Coronary Artery Disease
Ischemia
Regression Analysis
Confidence Intervals
Hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Outcomes after open infrainguinal bypass in patients with scleroderma. / Arhuidese, Isibor; Malas, Mahmoud; Obeid, Tammam; Massada, Karen; Khaled, Alaa; Alzahrani, Anas; Samaha, Georges; Reifsnyder, Thomas.

In: Journal of Vascular Surgery, 05.08.2015.

Research output: Contribution to journalArticle

Arhuidese, Isibor ; Malas, Mahmoud ; Obeid, Tammam ; Massada, Karen ; Khaled, Alaa ; Alzahrani, Anas ; Samaha, Georges ; Reifsnyder, Thomas. / Outcomes after open infrainguinal bypass in patients with scleroderma. In: Journal of Vascular Surgery. 2015.
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abstract = "Background: There are limited reports of outcomes after infrainguinal bypass surgery in patients with scleroderma. This study evaluated the long-term outcome after lower extremity bypass in these patients. Methods: The study included all patients with systemic sclerosis who underwent infrainguinal bypass surgery for severe peripheral arterial disease at our institution from January 1, 2007, to August 31, 2014. Kaplan-Meier and Cox regression analyses were used to evaluate graft failure and limb salvage. These outcomes were compared with those of nonscleroderma patients who underwent infrainguinal bypass surgery during the same period. Outcomes were defined and evaluated by Society for Vascular Surgery standards. Results: There were 18 autogenous grafts (6{\%} femoral-popliteal, 11{\%} femoral-tibial, 72{\%} popliteal-tibial, 11{\%} tibial-tibial) placed in 18 limbs from 12 patients with systemic sclerosis. Mean ± standard deviation age was 71 ± 9.5 years, and most of the patients were women (83{\%}) and white (78{\%}). All patients presented with critical limb ischemia. History of hypertension and coronary artery disease were 94{\%} and 61{\%}, respectively. All grafts used were autogenous, continuous, and harvested from the lower extremity (nonreversed great saphenous in 61{\%} and reversed great saphenous in 39{\%}). Mean follow-up duration was 2.3 ± 1.6 years. Graft failure was significantly higher in scleroderma patients than in nonscleroderma patients who underwent bypass in the same study period (hazard ratio, 7.2; 95{\%} confidence interval, 1.44-41.4; P = .02). The limb salvage rate was 72{\%}. Conclusions: Long-term outcomes after open infrainguinal bypass surgery in scleroderma patients are significantly worse than those in nonscleroderma patients. Careful consideration of their inherently poor outcomes should be made when reaching a decision for revascularization.",
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AU - Malas, Mahmoud

AU - Obeid, Tammam

AU - Massada, Karen

AU - Khaled, Alaa

AU - Alzahrani, Anas

AU - Samaha, Georges

AU - Reifsnyder, Thomas

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AB - Background: There are limited reports of outcomes after infrainguinal bypass surgery in patients with scleroderma. This study evaluated the long-term outcome after lower extremity bypass in these patients. Methods: The study included all patients with systemic sclerosis who underwent infrainguinal bypass surgery for severe peripheral arterial disease at our institution from January 1, 2007, to August 31, 2014. Kaplan-Meier and Cox regression analyses were used to evaluate graft failure and limb salvage. These outcomes were compared with those of nonscleroderma patients who underwent infrainguinal bypass surgery during the same period. Outcomes were defined and evaluated by Society for Vascular Surgery standards. Results: There were 18 autogenous grafts (6% femoral-popliteal, 11% femoral-tibial, 72% popliteal-tibial, 11% tibial-tibial) placed in 18 limbs from 12 patients with systemic sclerosis. Mean ± standard deviation age was 71 ± 9.5 years, and most of the patients were women (83%) and white (78%). All patients presented with critical limb ischemia. History of hypertension and coronary artery disease were 94% and 61%, respectively. All grafts used were autogenous, continuous, and harvested from the lower extremity (nonreversed great saphenous in 61% and reversed great saphenous in 39%). Mean follow-up duration was 2.3 ± 1.6 years. Graft failure was significantly higher in scleroderma patients than in nonscleroderma patients who underwent bypass in the same study period (hazard ratio, 7.2; 95% confidence interval, 1.44-41.4; P = .02). The limb salvage rate was 72%. Conclusions: Long-term outcomes after open infrainguinal bypass surgery in scleroderma patients are significantly worse than those in nonscleroderma patients. Careful consideration of their inherently poor outcomes should be made when reaching a decision for revascularization.

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