Predictors of Time to Graft Failure Following Infrainguinal Arterial Reconstruction

Infrainguinal arterial reconstruction increases limb salvage rates, however, the factors that predict time to graft failure remain ill-defined. The aim of this study was to define such predictors. A retrospective analysis of infrainguinal arterial reconstructions performed for symptomatic peripheral arterial disease refractory to medical/interventional therapies over a 6 year period was performed. Demographics and adverse outcomes were analysed and statistical significance was determined using Chi-squared analysis, the Student t test and the Wilcoxon signed-rank test. 170 procedures were analysed. The male to female ratio was 4:3. The median age was 70.1 years. The post-operative complication rate was 12%. On univariate analysis, female gender, the use of a synthetic graft, and the presence of critical ischaemia at the time of surgery were predictive of time to graft failure (p ≤ 0.05, p ≤ 0.03, p ≤ 0.02 respectively). On multivariate analysis, the 3 most significant predictors of graft failure were the occurrence of a post-operative complication, female gender and a high ASA grade. The presence of diabetes mellitus and smoking did not adversely affect graft outcome, (p ≤ 0.23, p ≤ 0.20 respectively). This study suggests that female gender adversely affects graft patency while a history of smoking and the presence of diabetes mellitus do not. Our findings also suggest that the occurrence of a post-operative complication, and a high ASA grade at time of surgery are additional important predictors of early and late graft failure.