Predictors of Early Graft Thrombosis During Index Admission for Lower Extremity Arterial Bypass

Early graft thrombosis following lower extremity bypass (LEB) has long served as a quality indicator of surgical management. A granular understanding the risk factors for might help mitigate potentially avoidable sequelae this complication. Our study utilized Vascular Quality Initiative (VQI) data to identify predictor variables associated with during index admission LEB. We queried VQI database patients receiving unilateral infrainguinal LEB between 2003 and 2022. Patients undergoing concomitant PVI or suprainguinal were excluded from our analysis. formed six procedural groups: femoral-above knee popliteal bypass, femoral-below femoral-tibial femoral-ankle popliteal-tibial popliteal-ankle bypass. Among these groups, we multivariable logistic regression modeling technical perioperative characteristics that predicted early thrombosis. Of 54,504 procedures met inclusion criteria, 11,906 (21.8%) underwent popliteal, 17,541 (32.2%) 19,224 (35.3%) femoral-tibial, 1414 (2.6%) femoral-ankle, 2661 (4.9%) popliteal-tibial, 1758 (3.2%) procedures. At time discharge, 1012 (1.9%) required intervention thrombotic intervention, 814 (1.5%) occluded. After adjusting patient comorbidities, identified independent predictors thrombosis: female gender, distal target, symptomatic indication (rest pain tissue loss), urgent/emergent presentation, anticoagulation therapy, specifically warfarin rivaroxaban. Conversely, use preoperative statin, aspirin clopidogrel was protective against (Table). There 9.5% not one several medications (25.9% statins, 69.1% clopidogrel, 27.6% aspirin). With regard type conduit used LEB, native vein conduits demonstrated lowest odds (Table, Figure). In large national contemporary have including rivaroxaban therapy nonautologous antiplatelet Despite their beneficial effect, population are statin and/or therapies, which serves potential improvement initiative. findings suggest utilization when possible, promoting aggressive medical optimization P2Y12 inhibitors may avoid occlusion in requiring revascularization.TableMultivariable model indicating after arterial surgeryPerioperative characteristicsOdds ratio (95% confidence interval)P valueAge0.99 (0.98-0.99)<.001Female sex1.32 (1.20-1.45)<.001White race1.10 (1.00-1.22).059Diabetes0.83 (0.75-0.92)<.001Dialysis1.02 (0.93-1.13).638Congestive heart failure1.03 (0.89-1.18).731Prior coronary artery grafting0.87 (0.79-0.96).008Chronic obstructive pulmonary disease0.94 (0.83-1.05).266Smoking0.82 (0.73-0.93).002Aspirin0.73 (0.66-0.81)<.001Statin0.85 (0.77-0.95).003Baseline hemoglobin0.92 (0.90-0.95)<.001BMI1.00 (0.99-1.01).835Bypass Femoral above popliteal1 (reference)- below popliteal1.62 (1.30-2.03)<.001 tibial vessel3.18 (2.58-3.90)<.001 ankle vessel4.41 (3.28-5.93)<.001 Popliteal vessel2.58 (1.98-3.37)<.001 vessel3.15 (2.32-4.28)<.001Urgency Elective1 Urgent1.74 (1.54-1.97)<.001 Emergent3.45 (2.75-4.34)<.001Conduit Native vein1 Dacron1.09 (0.56-2.11).810 Polytetrafluoroethylene1.36 (1.20-1.55)<.001 Nonautologous biologic2.41 (1.95-2.97)<.001Indication Asymptomatic1 Claudication1.02 (0.53-1.97).953 Rest Pain2.44 (1.28-4.66).007 Tissue loss2.18 (1.16-4.11).016 Acute ischemia3.39 (1.77-6.49)<.001 Not treated2.53 (1.34-4.77).004Per hour procedure time1.00 (1.00-1.00)<.001Preoperative antagonist None1 Clopidogrel0.81 (0.73-0.91)<.001 Prasugrel1.14 (0.58-2.24).697 Ticagrelor0.93 (0.49-1.75).818 Other0.81 (0.30-2.16).668 No, reasons0.69 (0.50-0.96).027 Noncompliant1.35 (0.75-2.45).314Preoperative Warfarin1.38 (1.16-1.65)<.001 Dabigatran1.06 (0.49-2.31).874 Rivaroxaban1.42 (1.15-1.75).001 Other1.54 (1.29-1.85)<.001 reasons1.14 (0.74-1.74).548 Noncompliant2.35 (1.27-4.35).007Presented ratios interval) age, sex, race, diabetes, dialysis, congestive failure, prior grafting, chronic disease, smoking, aspirin, anticoagulation, body mass index, urgency, indication, total time. Boldface entries indicate statistical significance. Open table new tab