Factors Affecting The Longevity Of Femoropopliteal Bypasses

The longevity of femoropopliteal bypass grafts is affected by both patient and bypass related factors. Patients with CLI (critical limb ischemia) often also have other coexisting medical condition such as diabetes, chronic renal insufficiency that can negatively impact the outcome of the bypass procedure regardless of the success of the surgery alone. Advanced distal disease with poor runoff status also affects the success of this procedure. Low estimated GFR is an independent marker of poor prognosis after infrainguinal bypass in patients with critical limb ischemia. The overall benefit from infrainguinal bypass may, however, be limited in the very elderly because advanced age is associated with increased perioperative and postoperative mortality after vascular operations. Continued smoking after lower limb bypass surgery results in a threefold increased risk of graft failure. 1-year patency rate of 63% for smokers as opposed to the 84% rate for nonsmokers has been observed [1]. Smoking has been associated with an increased risk of occlusion of femoropopliteal saphenous vein grafts. Coagulation disorders are a risk factor not only for early but also for late vein graft failure. Patients with hypercoaguable states had poorer primary and secondary patency rates after 5 years of bypass procedure [1]. Degree of ischemia also plays an important role in determining the outcome of the procedure. Patients with preexisting gangrene, ulceration and rest pain have poorer outcomes after the procedure [1].