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Prior Endovascular Intervention Is Not Detrimental to Pedal Bypasses for Ischemia
Jon C. Henry, Aureline Boitet, MD, Abhisekh Mohaptra, MD, Efthymios Avgerinos, MD, Rabih Chaer, MD, Michel Makaroun, MD, Steven Leers, Eric S. Hager, MD.
UPMC, Pittsburgh, PA, USA.

Introduction:
Distal bypasses to pedal arteries are used to help treat ischemic foot wounds secondary to infrapopliteal arterial disease. Prior to the bypass patients often may have prior endovascular interventions on the tibial vessels. This study evaluates the effects prior endovascular interventions on subsequent bypasses and the rates of ischemic foot wound healing.
Methods:
Patients between 2006 to 2013 presenting with ischemic foot wounds (Rutheford Class V and VI wounds), documented infrapopliteal arterial disease, and who underwent a surgical bypass to pedal arteries were included. Patients were excluded if a prior distal bypass had been performed. A retrospective chart review was then conducted for patient demographics, past medical history, extent of disease, prior tibial endovascular interventions, the treatment intervention, subsequent interventions, the wound healing status, and limb salvage. Wounds were considered healed based upon office or inpatient documentation.
Results:
From 130 surgically bypassed potential limbs, 95 were bypassed without prior intervention and 27 had a preceding endovascular intervention with mean follow-up of 24.5±23.4 and 20.5± 17.8 months respectively (p=0.356). The two groups were comparable in co-morbidities with the exception of the prior intervention group having higher rates of malignancy (22.2% vs. 6.3%, p=0.024) warfarin use (37.0% vs. 16.8%, p=0.033) and anti-platelet therapy (74.1% vs. 43.8%, p=0.008). Runoff scores were similar between the two groups (4.8±2.2 for no intervention and 5.0±1.9 for those with a prior intervention, p=0.594). At 12 months, those without an intervention before bypass compared to those with a previous intervention had a longer primary patency (60.7% vs 35.0%, p=0.041). Primary-assisted patency was similar (79.4% vs. 74.2%, p=0.540), as well as similar secondary patency (80.0% vs 74.2%, p=0.405). Wound healing was improved in those patients who had a prior endovascular intervention with 67.8% healed at one year compared to only 37.0% of those without intervention (p=0.019). Major amputation-free survival was not different with both having over 80% limb salvage at one year (p=0876).
Conclusions:
A previous endovascular intervention does not have a detrimental affect on overall patency of pedal bypasses. There appears to be no change in amputation-free survival nor prolongation of wound healing.


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