LAUSR

INTRODUCTION Infrainguinal bypass performed after a previous prosthetic inflow reconstruction offers a choice of where to perform the proximal anastomosis. The hood of a prior inflow bypass may be technically easier to isolate during the reoperative surgery. However, the more distal native artery may offer better patency to the outflow revascularization. The purpose of this study is to compare outcomes of infrainguinal bypass using either the hood of a prior inflow bypass versus native artery as inflow. METHODS A single vascular group's database was queried for all infrainguinal bypasses performed after prior prosthetic inflow bypass to a femoral artery between January 2006 and December 2016. Demographics, indications, operative details, and long-term results were recorded and analyzed. Two groups were compared based upon location of the proximal anastomosis for distal bypass. One group derived their inflow for distal bypass off the hood of a previous inflow graft (HOOD) while the other group utilized the distal native (NATV) arterial tree as inflow. Subset analysis for patency of the distal bypass was also performed between the two groups when the previous inflow reconstruction occluded. Patency was calculated using Kaplan-Meier method. RESULTS One hundred ninety-seven patients underwent infrainguinal bypass after prior inflow bypass from 2006-2016. 59 (30%) bypasses used the hood of prior bypass as inflow (HOOD) and 138 (70%) used the native artery distal to the hood of the inflow bypass as an inflow source (NATV). Indications were similar between groups. Group demographics had similar rates of males, hypertension, hyperlipidemia, coronary artery disease, tobacco use and renal disease. Prior inflow procedures were similar between groups. The native artery used for inflow in the NATV group were profunda femoris (80, 58%), common femoral (51, 37%), and superficial femoral (7, 5.1%). Patency between the groups was significantly higher for the NATV group at 1 year (91% vs 75% P=.0221). Patency rates after inflow bypass occlusion significantly favored NATV at 1 year (87% vs 40% P=0.0035). CONCLUSION Infrainguinal bypass performed after prior ipsilateral inflow bypass offers the option of using the hood of the bypass or native artery as inflow. This study demonstrated higher patency rates when using the distal native artery as inflow. The native artery option also offered continued patency when the inflow bypass occluded.