Vascular Surgery

Contemporary outcomes for non-autologous above-knee femoropopliteal bypass

This systematic review/meta-analysis pooled 16 records (2,083 patients) undergoing ATK femoropopliteal non-autologous bypass. Pooled primary patency was 0.80 at 12 months and 0.69 at 24 months, with secondary patency higher at 12 months (0.86). Pooled 36-month mortality was substantial at 0.24, and limb salvage rates were high through 24 months. These results provide contemporary benchmarks for counseling when autologous conduit is unavailable. 1

No survival benefit of multiarterial grafting after IV adjustment in Medicare CABG

In 1,291,314 Medicare CABG patients, conventional risk-adjusted models suggested a modest MAG survival gain of 0.41 years. An instrumental-variable analysis using surgeon MAG rate showed no survival difference (both 10.38 years median). This suggests residual confounding may explain observational MAG survival signals in older patients. Apply caution when extrapolating nonrandomized MAG survival benefits to Medicare-aged populations. 2

High rates of clopidogrel nonresponse and elevated vWF before major vascular surgery

In this single-centre prospective cohort of 64 operative patients, antiplatelet resistance ranged widely, with clopidogrel resistance 70% at baseline. Von Willebrand factor exceeded normal in about two-thirds of patients, and two early graft/stent thromboses occurred with clopidogrel resistance and high vWF. Cessation of clopidogrel 5–7 days pre-op did not produce a statistically significant recovery in platelet function in exploratory analysis. Findings challenge assumptions that standard stopping intervals normalize platelet function before major vascular operations. 3