{
    "abstract": "Revascularization after lower extremity bypass failure poses many challenges. Despite nearly 7 decades of experience with lower extremity revascularization, there is little data on the success of redo bypass particularly when autogenous conduit is utilized. The purpose of this study is to review outcomes of redo infrainguinal bypass constructed solely of autogenous vein.\nAll patients who underwent redo infrainguinal bypass at a single institution by a single surgeon were retrospectively reviewed. Bypasses were categorized into 3 groups: femoral-popliteal, femoral-distal, and popliteal-distal bypasses. Since the repeat bypasses were all done for limb salvage, freedom from above or below knee amputation (FFA) was primary outcome, which was defined as the number of days from redo bypass to subsequent amputation or the most recent follow-up.\nFrom 2006 to 2016, 100 limbs underwent redo bypass. Fifty-nine (59.0%) limbs had undergone one previous bypass while 41 (41.0%) had undergone 2 or more. The redo configurations consisted of 23 (23.0%) femoral-popliteal, 70 (70.0%) femoral-distal, and 7 (7.0%) popliteal-distal bypasses. Ninety-seven (97.0%) underwent redo using autologous vein grafts including 41 (95.5%) of those who had 2 or more previous bypasses. The 3 patients who ultimately underwent prosthetic bypass had bilateral great and small saphenous veins and bilateral basilic and cephalic veins previously harvested. Nine (9.0%) limbs were subsequently amputated: 2 (2.0%) above knee and 7 (7.0%) below knee amputations. Of these, all had had 2 or more previous bypasses and 2 of the 3 patients who ultimately received prosthetic bypasses were in this group. In patients with one previous bypass, FFA was 775\u00a0days (IQR: 213-1,626\u00a0days). In patients with 2 or more previous bypasses, FFA was 263\u00a0days (IQR: 106-1,148\u00a0days). No patients with femoral-popliteal bypasses suffered amputation while 7 (10.0%) of the femoral-distal and 2 (28.6%) of the popliteal-distal bypasses suffered subsequent amputations (P\u00a0=\u00a00.067).\nRedo infrainguinal bypass is effective in salvaging threatened lower extremities. Furthermore, once a patient is deemed a bypass candidate, revascularization with autologous vein can be achieved. A significant FFA rate is achieved with redo bypass, although patients with more distal disease are harder to salvage.",
    "authors": [
        {
            "affiliation": "Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD. Electronic address: cfrase11@jhmi.edu.",
            "firstname": "Charles D",
            "initials": "CD",
            "lastname": "Fraser"
        },
        {
            "affiliation": "Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.",
            "firstname": "Mark L",
            "initials": "ML",
            "lastname": "Kovler"
        },
        {
            "affiliation": "Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.",
            "firstname": "Rui Han",
            "initials": "RH",
            "lastname": "Liu"
        },
        {
            "affiliation": "Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.",
            "firstname": "Robert J",
            "initials": "RJ",
            "lastname": "Beaulieu"
        },
        {
            "affiliation": "Division of Vascular Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD.",
            "firstname": "Thomas",
            "initials": "T",
            "lastname": "Reifsnyder"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2019 Elsevier Inc. All rights reserved.",
    "doi": "10.1016/j.avsg.2019.10.070",
    "journal": "Annals of vascular surgery",
    "keywords": [],
    "methods": null,
    "publication_date": "2019-11-05",
    "pubmed_id": "31678127",
    "results": "From 2006 to 2016, 100 limbs underwent redo bypass. Fifty-nine (59.0%) limbs had undergone one previous bypass while 41 (41.0%) had undergone 2 or more. The redo configurations consisted of 23 (23.0%) femoral-popliteal, 70 (70.0%) femoral-distal, and 7 (7.0%) popliteal-distal bypasses. Ninety-seven (97.0%) underwent redo using autologous vein grafts including 41 (95.5%) of those who had 2 or more previous bypasses. The 3 patients who ultimately underwent prosthetic bypass had bilateral great and small saphenous veins and bilateral basilic and cephalic veins previously harvested. Nine (9.0%) limbs were subsequently amputated: 2 (2.0%) above knee and 7 (7.0%) below knee amputations. Of these, all had had 2 or more previous bypasses and 2 of the 3 patients who ultimately received prosthetic bypasses were in this group. In patients with one previous bypass, FFA was 775\u00a0days (IQR: 213-1,626\u00a0days). In patients with 2 or more previous bypasses, FFA was 263\u00a0days (IQR: 106-1,148\u00a0days). No patients with femoral-popliteal bypasses suffered amputation while 7 (10.0%) of the femoral-distal and 2 (28.6%) of the popliteal-distal bypasses suffered subsequent amputations (P\u00a0=\u00a00.067).",
    "title": "Contemporary Outcomes following Redo Autogenous Infrainguinal Bypass.",
    "xml": "<Element 'PubmedArticle' at 0x788504d0d080>"
}