PC70. Acute Limb Ischemia After Cardiothoracic Surgery Is Associated With High Rates of Amputation and Mortality

Objectives: Failure of a femoropopliteal bypass often necessitates redo lower extremity surgery and is associated with increased mortality and morbidity. An alternative strategy is to perform endovascular revascularization of the superficial femoral artery (SFA) and avoid catheter-directed lysis or open surgery. The purpose of this retrospective study was to examine the outcomes of native SFA chronic total occlusion (CTO) recanalization compared with bypass after failed femoropopliteal bypass. Methods: Patients presenting with a symptomatic failed femoropopliteal bypass who underwent attempted CTO recannulization of the native SFA or a redo femoropopliteal bypass from2000 to 2014were included. Patients undergoing catheter-directed thrombolysis were excluded. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Factor analyses were performedusing aCoxproportional hazardmodel for time-dependentvariables. Results: A total of 104 patients (69% male, average age 65 years) underwent nativeCTO recannulization (n1⁄4 40) or redobypass (n1⁄4 64) after presentation with symptomatic occlusion of a previous femoropopliteal bypass graft (rest pain in 84% and life style-limiting claudication in 16%, 79% to the aboveknee popliteal), 81% of the lesions being TASC-II category D and 19% TASC-II category C. Tibial runoff was one tibial vessel in most patients (79%) and two-vessel runoff in the remainder. Lesions treated endovascularly underwent primary stenting with a median of three stents used. Sixty-nine percent of the bypasses were to the below-knee popliteal and remainder to the proximal tibials (68% of the patients has venous conduit). Overall, 30-day major adverse cardiac eventswere 5.6%andall-causemorbiditywas6.3%. 30-daymajor adverse limbevents was 17% and30-day amputation ratewas 8% (Table).Overall amputation-free survival was 43%6 9% and freedom frommajor adverse limb events was28%6 7%at3years (Table).Critical ischemia,TASC-II lesion (D), andonevessel tibial runoff were significant predictors of failure.