Peripheral Vascular Surgery Society

Introduction: Incisional complications occurring after infrainguinal vein bypass grafting remain a formidable challenge to the vascular surgeon. A retrospective analysis was undertaken to identify which predisposing factors are important in the development of incisional complications, and to determine the impact of incisional complications on outcome.

Methods: 250 infrainguinal vein bypass grafts (220 patients) were reviewed. Incisional complications occurred in 47 (19%) of the bypasses. The mean age was 55 years and 155 (62%) of the bypasses were performed in men. Patients were grouped based on the presence or absence of an incisional complication. The data were analyzed by life-table, t-test and chi-square methods where appropriate.

Results: A serum albumin <3.5 g/dl and dialysis dependence were independent risk factors for incisional complications (p<0.05). Age, body mass index, total lymphocyte count, hematocrit, race, indication for surgery, prior contralateral bypass, prior contralateral amputation, cancer, diabetes, cardiac disease, tobacco use, hypertension, stroke, and hypercholesterolemia were not predictive for incisional complications. Prior ipsilateral infrainguinal bypass (p=0.06), female gender (p=0.08) and hemoglobin <12 g/dl (p=0.08) trended toward incisional complications. By life-table analysis there was no difference between primary patency (p=0.73), cumulative patency (p=0.91), limb salvage (p=0.69) or survival (p=0.92) between groups. However, a significant suppurative soft tissue infection was ultimately associated with a poor outcome.

Conclusion: Nutritional compromise (serum albumin <3.5 g/dl) and dialysis dependence are factors which are predictive for incisional complications after infrainguinal vein bypass grafting. Infection does have a negative impact. Other incisional complications do not significantly alter primary patency, cumulative patency, limb salvage or survival.