(IP161) Concomitant Suprainguinal Bypass with Infrainguinal Revascularization Procedures Are Safe and Effective in Combined Aortoilio-Femoral Occlusive Disease

Objectives: Extra-anatomic suprainguinal bypass (SIB) has traditionally been offered to patients with significant aortoiliac disease and concurrent hostile abdomens or advanced cardiopulmonary disease when an endovascular approach is not feasible. In the presence of aortoiliac and femoral occlusive disease requiring extra-anatomic SIB, simultaneous revascularization of the infrainguinal segment may be performed either through a concomitant infrainguinal bypass (IIB) or peripheral vascular intervention (PVI). This study aims to compare the safety and efficacy of the two approaches.

Methods: Patients undergoing extra-anatomic SIB for CLTI were identified in the Vascular Quality Initiative (VQI) between 2010-2020. Extra-anatomic SIB included axillo-femoral bypass and crossover femoral-femoral bypass. Patients were classified into two groups: those receiving SIB with concomitant IIB (SIB+IIB), and those receiving SIB with concomitant infrainguinal PVI (SIB+PVI). Patients undergoing SIB+PVI were one-to-five propensity score matched to patients undergoing SIB+IIB. Kaplan Meier and Cox-regression analysis were used to evaluate the long-term outcomes of major amputation (above-ankle amputation) and mortality.

Results: A total of 1,310 patients (1107 males, 540 females) with a mean age of 67 years underwent SIB with concomitant infrainguinal revascularization. 1,310 (80%) patients who underwent SIB+IIB were matched to 337 (20%) patients who underwent SIB+PVI. After matching, the two groups were similar in all demographics and pre-operative characteristics. The 30-day, 1-year, and 5-year mortality rates were 5%, 15% and 30% respectively. At 1-year follow-up, the two groups had similar rates of major amputation (8% vs 7%, p=0.307), re-intervention (16% vs 13%, p=0.160), and major adverse limb events (22% vs 20%, p=0.179). No difference in long-term mortality was observed the two groups (p=0.447) (Figure 1).

Conclusions: This study demonstrates that concomitant infrainguinal revascularization during extra-anatomic SIB is a safe procedure that can be performed with similar efficacy using either IIB or PVI. Both approaches show comparable long-term outcomes in terms of limb salvage and mortality. Accordingly, these findings can be tailored based on individual patient characteristics and clinical considerations without compromising outcomes.