Analysis of Risk Factors for the Development of Femoropopliteal Bypass Graft Occlusions

Abstract To identify significant risk factors for femoropopliteal bypass graft occlusions. A retrospective case-control study included patients who had undergone femoropopliteal bypass due to lower extremity arterial disease at the Clinical Centre Kragujevac, Serbia, between 2008. and 2011. The cases (n = 35) were patients with femoropopliteal bypass graft occlusion which required surgical intervention. The control group (n = 70) consisted of patients without graft occlusion. The cases and controls were age and sex matched. Significant impact on graft occlusion was found for the form of femoropopliteal bypass(OR adjusted 115.34; 95%CI 4.02,3306.55;), type of graft(OR adjusted 81.62; 95%CI 1.03,6486.32), cardiovascular disease(OR adjusted 55.64; 95%CI 2.63,1176.94), previous vascular procedures(OR adjusted 51.61; 95%CI 1.10,2425.14), preoperative disease stage according to Rutherford(OR adjusted 22.21; 95%CI 2.62,188.39), and preoperative hematocrit levels (OR adjusted 0.34; 95%CI 0.13,0.89). A significant synergistic effect on graft occlusion was observed for the combination of form of bypass and type of graft, combination of type of graft and previous vascular procedures, combination of form of bypass and cardiovascular diseases, combination of type of graft and cardiovascular diseases, combination of type of graft and preoperative disease stage, and combination of form of bypass and preoperative disease stage. The results of our study suggest that previous and concomitant cardiovascular diseases and severity of the vascular disease itself should always be taken into account together with type of the graft and type of the operative procedure when planning femoropopliteal bypass in a patient with lower extremity vascular disease.