Post‐operative transfusion is associated with infrainguinal bypass graft failure: contemporary Australian tertiary centre experience

Abstract

AbstractBackgroundsPeripheral arterial disease (PAD) is an increasingly prevalent and highly morbid pathology affecting the older population. Infra‐inguinal bypass (IIB) surgery remains a robust revascularization option in these patients. This study aimed to identify modifiable predictors associated with graft patency and functional outcomes in contemporary Australian vascular surgical practice.MethodsA retrospective analysis of patients undergoing IIB between 2010 and 2020 at a tertiary vascular surgery centre in Australia was performed. Data regarding patient demographics, co‐morbidities, pre‐operative investigations, bypass characteristics, and discharge outcomes were collected. Surveillance ultrasound scans were reviewed to gain information on graft patency and compliance up to 2 years post‐operatively. The primary outcome was graft failure. Secondary outcomes were mobility status and amputation‐free survival at 1 year.ResultsA total of 239 IIBs were performed on 207 patients during the 10‐year period. Significant predictors for primary graft occlusion included regional referral (P < 0.01), low pre‐operative haemoglobin level (P < 0.01), post‐operative transfusion requirement (P = 0.02), use of prosthetic conduit (P < 0.01) and non‐compliance to ultrasound surveillance (P < 0.01). Patients with a thrombosed graft were 2.4 times more likely to experience deterioration in mobility status (P < 0.01) and 8.6 times more likely to have major limb amputation or death at 1 year. The amputation‐free survival was 88.3% at 1 year.ConclusionOptimization of pre‐operative haemoglobin level for IIB should be advocated in clinical practice in order to reduce the risk of graft failure, deterioration in ambulatory function, major limb amputation and mortality.