Superficial tunnelling technique not associated with patency or amputation in patients with limb ischaemia

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The results of a recent investigation have revealed no association between infrainguinal bypass tunnelling technique and primary outcomes in patients with limb ischaemia. “Compared to subfascial tunnelling,” write Nallely Saldana-Ruiz (University of Southern California, Los Angeles, USA) and colleagues in the Journal of Vascular Surgery (JVS), “the superficial tunnelling technique is not associated with primary patency or major amputation in limb ischaemia patients undergoing infrainguinal bypass with a single-segment great saphenous vein”.

Saldana-Ruiz et al detail in JVS that they queried the National Vascular Quality Initiative database infrainguinal bypass module from 2008–2017 in order to address a potential association between tunnelling technique and outcomes. They also communicate that tunnelling type was not associated with primary patency, primary-assisted patency, secondary patency, or major amputation, according to multivariate analyses (p>0.05).

The main exposure variable, Saldana-Ruiz and colleagues relay, was the type of tunnelling—either subcutaneously or subfascially. Primary outcomes were primary patency and amputation, while secondary outcomes included primary-assisted patency and secondary patency. They detail: “We excluded non-greater saphenous vein grafts, grafts using multiple segments, indications of aneurysmal disease, bypass locations outside of femoral to below-knee popliteal artery or tibial arteries, and those missing data on the tunnelling type and limb ischaemia”.

The investigators state that they included a total of 5,497 bypasses—2,835 subcutaneous and 2,662 subfascial—in their study. Writing in JVS, they report the following headline results: “Age, race, graft orientation (reversed/non-reversed), bypass donor and recipient vessels, harvest type, end-stage renal disease, smoking, coronary artery bypass graft, congestive heart failure, P2y12 inhibitor at discharge, surgical site infection at discharge, and indication (rest pain/tissue loss/acute ischaemia) were associated with tunnelling technique,” stating a p-value of <0.05.


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