(PC202) Prosthetic Conduits Are Used In Nearly 50% of Infrainguinal Bypasses Performed for Chronic Limb-Threatening Ischemia

Friday, June 6, 2025

12:30 PM - 2:00 PM CT

Submitting & Presenting Author(s)

Chen Dun, PhD, MS

PhD candidate in Biomedical Informatics and Data Science
Johns Hopkins Hospital
Baltimore, Maryland

Co-Author(s)

Terrence Tsou, BA (he/him/his)

Medical Student
The Johns Hopkins University School of Medicine
Baltimore, Maryland
AW

Andrew Wu
KM

Katherine M. McDermott

General Surgery Resident
Johns Hopkins University School of Medicine
Baltimore, Maryland
OT

Olivia Tan

General Surgery Resident
Johns Hopkins University
Baltimore, Maryland
MW

Midori White

General Surgery Resident Physician
Johns Hopkins University
Jeffrey J. Siracuse, MD, MBA

Professor of Surgery and Radiology, Chief of Vascular and Endovascular Surgery
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
Boston, Massachusetts
Christopher J. Abularrage, MD

Professor of Surgery
Johns Hopkins University
Baltimore, Maryland
Ying-Wei Lum, MD

Associate Professor, Vascular Surgery
Johns Hopkins Hospital
Baltimore, Maryland
James H. Black, III, MD

Professor, Vascular Surgery
Johns Hopkins Hospital
Baltimore, Maryland
Mm

Martin A. makary

Professor of Surgery
Johns Hopkins University School of Medicine
Baltimore, Maryland

Senior Author(s)

Caitlin W. Hicks, MD, MS (she/her/hers)

Associate Professor, Vascular Surgery
Johns Hopkins Hospital
Baltimore, Maryland

Objectives: Objectives
The BEST-CLI study demonstrated the benefit of autogenous vein grafts for infrainguinal lower extremity bypass in patients with chronic limb-threatening ischemia (CLTI). However, physician practice patterns and real-world outcomes data are lacking. We aimed to describe trends in physician practice patterns and evaluate clinical outcomes associated with prosthetic vs. vein bypass grafts in CLTI patients.

Methods: Methods
We conducted a retrospective analysis using 100% Medicare fee-for-service claims data from 01/2017 to 12/2022 to identify patients underwent a first-time infrainguinal bypass for CLTI. Patients with prior bypasses and coronary artery bypass grafts were excluded. Proportional use of prosthetic vs. vein grafts were calculated for each surgeon, and change in prosthetic graft use was assessed over time. Multivariable logistic regression and Cox proportional hazards models were used to assess factors associated with prosthetic graft use and subsequent clinical outcomes.

Results: Results
28,262 patients underwent an infrainguinal bypass for CLTI from 744 physicians (mean patient age 72.9 years, 65.0% male, 17.1% Black), of which 44.2% received a prosthetic graft. Vein patches were used in 5.2% of the prosthetic grafts. The median physician-level prosthetic graft rate was 41.7%, ranging from 0% to 100% (Figure 1). Prosthetic graft use increased significantly over time (0.4% per year, 95% CI: 0.2-0.7%), and was more common in females (aOR:1.3, 95% CI: 1.2-1.4), non-white patients (aOR:1.2, 95% CI: 1.1-1.3), and for popliteal (vs. tibial) targets (aOR: 3.1, 95% CI: 2.9-3.3). After risk adjustment, prosthetic grafts were associated with worse clinical outcomes including conversion to acute limb-threatening ischemia (ALI), major amputation, major reintervention, bypass graft revision, thrombectomy, thrombolysis, and excision of infected graft. (Figure 2).

Conclusions: Conclusions
The persistence of prosthetic graft use despite multiple landmark trials, including BEST-CLI, highlights a gap in translating clinical trial evidence into practice. Collaborative efforts involving professional societies, health systems, and policymakers are essential to promote adherence to evidence-based practices and optimize care for CLTI patients.