Factors Associated With Limb Failure to Rescue After Infrainguinal Bypass Surgery

Bypass graft failure and major amputation are among the most dreaded complications of infrainguinal bypass surgery. In this large multicenter analysis, we examined incidence risk factors for limb to rescue (FTR) after either surgery or failure. A prospectively maintained, database was retrospectively queried all procedures performed between 2002 2021. Redo bypasses were excluded. The primary outcome FTR, defined as ipsilateral within 90 days index requiring reintervention critical stenosis occlusion graft. Graft without subsequent days. Multivariable logistic regression analysis used identify FTR. Over study period, 1315 across five hospitals. There 25 amputations initial bypass. diagnosed in an additional 503 (38.3%) patients. median time 239 (interquartile range: 90-667 days). On multivariable tissue loss (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.03-1.83; P = .03) only factor identified Of patients with failure, 33 had amputation, leading overall FTR 4.4% (n 58) over a follow-up period 1.7 years (Fig). Patient demographics, medical comorbidities, conduits similar groups NS each). group more frequently underwent (51.7% vs 29.8%, .002), infrageniculate target compared (81.0% 60.4%, .002). Anticoagulation (34.5% 37.7% rescue) dual antiplatelet therapy (15.5% 22.1%, respectively) (P Risk included (OR: 2.42, CI: 1.22-4.08; .01), Black race 2.47, 1.04-5.84; .04), 4.75, 1.41-16.0; .01). not associated patency Limb is nonmodifiable may represent progression underlying disease. These data help inform vascular surgeons counseling failing grafts. Further investigation care delivery improving likelihood salvage be warranted.