Searching for the Optimal Predictors’ Model for Occlusion of the Femoral-popliteal and Femoral-tibial bypasses

Cover Page

Cite item


Risk factors affecting the patency of shunts after infrainguinal reconstructions have been known for a long time. But so far, no effective model has been proposed, that allows to predict in a particular patient at what time and with what combination of risk factors bypass occlusion will occur. A statistical analysis of the risk factors for occlusion of such bypasses was made and developed a reliable prognostic model based on the regression function. A retrospective analysis of 136 cases of femoral-popliteal bypasses and femoral-tibial bypasses was carried out at the Department of Vascular Surgery of the Orel Regional Clinical Hospital from 2008 till 2018. Statistical data analysis was performed using Spearman’s rank correlation, binary logistic regression, ROC-curve and Kaplan-Meier survival graphs using IBM SPSS Statistics 22. A correlation was found between almost all analyzed factors and primary permeability. Based on the logistic regression, a reliable model of a combination of ischemia, superficial femoral artery patency, diabetes history, pre-operative INR data and hemoglobin level, with high prognostic significance, specificity, sensitivity and informativeness, was compiled. The constructed Kaplan-Meier survival graphs showed the dependence of the degree of ischemia and trophic disorders, history of diabetes, and the use of clopidogrel, atorvastatin / rozuvastatin, pentoxifylline, actovegin in the postoperative period from the primary patency over the time. To the patients, who have occlusion risk factors proposed in the developed model, should prolonged atorvastatin/rosuvastatin, clopidogrel, pentoxifylline, actovegin intake (more than 1 year, ideally for life) first be advised, and also they should appoint a periodic preventive examination of a vascular surgeon after 1 month, 3 months, 6 months, 1 year and 2 years after surgery with an ultrasound scan of the lower limb arteries and a bypass, as well as a complete blood count analysis (leukocytes and platelets).

About the authors

B. V. Kasyanov

Orel State University

Author for correspondence.
Orel, Russian Federation


  1. Papojan S.A., Shhegolev A.A., Gavrilenko A.V. Sovremennye podhody k hirurgicheskomu i jendovaskuljarnomu lecheniju porazhenij aortopodvzdoshnogo segmenta. Annaly hirurgii. 2015. No. 5. S. 11—17.
  2. Bagdasarjan A.G. Opyt primenenija preparatov acetilsalicilovoj kisloty v angiohirurgicheskoj praktike. RMZh. 2014. Vol. 22. No. 30. S. 2136—2139.
  3. Koshkin V.M. et al. Konservativnaja terapija u bol'nyh hronicheskimi obliterirujushhimi zabolevanijami arterij nizhnih konechnostej. Sovremennye predstavlenija. Medicinskij sovet. 2015. No. 8. S. 6—9. 10.21518/2079-701X-2015-8-6-9.
  4. TASC Steering Committee et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Vascular Medicine. 2015. Vol. 20. No. 5. S. 465—478.
  5. Mitichkin A.E. et al. Sochetannye jendovaskuljarnye i rekonstruktivnye operacii pri mnogojetazhnyh porazhenijah arterij nizhnih konechnostej. Annaly hirurgii. 2016. Vol. 21. No. 3. S. 182—192.
  6. Chernjavskij M.A. et al. Klinicheskij sluchaj gibridnogo lechenija pacienta s mnogourovnevym ateroskleroticheskim porazheniem arterij nizhnih konechnostej. Patologija krovoobrashhenija i kardiohirurgija. 2018. Vol. 22. No. 4. S. 103—110.
  7. Nikonenko A.S., Voloshin A.N., Materuhin A.N. Effektivnost' endovaskuljarnoj rekanalizacii bedrenno-podkolennogo segmenta u bol'nyh s kriticheskoj ishemiej nizhnih konechnostej. Vіsnik sercevo-sudinnoї hіrurgії. 2015. № 23. S. 130—134.
  8. Mun Y.S. et al. Femoropopliteal Bypass with Varicose Greater Saphenous Vein. International Journal of Angiology. 2016. Vol. 25. No. 05. С. e108—e110.
  9. Schulman M.L., Badhey M.R. Regarding. Autologous alternative veins may not provide better outcomes than prosthetic conduits for below-knee bypass when great saphenous vein is unavailable. Journal of vascular surgery. 2016. Vol. 63. No. 4. С. 1131. 10.1016/j.jvs.2015.11.048
  10. De Santis F. et al. Factors Affecting Long-Term Results of Above-Knee Femoropopliteal Bypass: A Single-Center Contemporary Study. Vascular and endovascular surgery. 2016. Vol. 50. No. 2. С. 72—79. 1538574415627866.
  11. Klinkert P. et al. Saphenous vein versus PTFE for above-knee femoropopliteal bypass. A review of the literature. European journal of vascular and endovascular surgery. 2004. Vol. 27. No. 4. P. 357—362. 10.1016/j.ejvs.2003.12.027
  12. Sayers R.D. et al. Long‐term results of femorotibial bypass with vein or polytetrafluoroethylene. British journal of surgery. 1998. Vol. 85. No. 7. С. 934—938.
  13. Altreuther M., Mattsson E. Long-Term Limb Salvage and Amputation-Free Survival After Femoropopliteal Bypass and Femoropopliteal PTA for Critical Ischemia in a Clinical Cohort. Vascular and endovascular surgery. 2019. Vol. 53. No. 2. P. 112—117. 10.1177/1538574418813741.
  14. Rutherford R.B. et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. Journal of vascular surgery. 1997. Vol. 26. No. 3. P. 517—538.
  15. Klingelhoefer E. et al. Predictive factors for better bypass patency and limb salvage after prosthetic above-knee bypass reconstruction. Journal of vascular surgery. 2016. Vol. 64. No. 2. P. 380—388. j.jvs.2016.02.059.
  16. Matjushkin A.V., Lobachev A.A. Otdalennye rezul'taty razlichnyh metodov hirurgicheskoj revaskuljarizacii u bol'nyh s okkljuziej bedrenno-podkolennogo segmenta. Vestnik Nacional'nogo mediko-hirurgicheskogo Centra im. N.I. Pirogova. 2018. Vol. 13. No. 2. S. 18—25.
  17. Sukovatyh B.S. et al. Bedrenno-podkolennoe shuntirovanie svobodnym autovenoznym transplantatom nizhe shheli kolennogo sustava v lechenii kriticheskoj ishemii nizhnih konechnostej. Novosti hirurgii. 2015. Vol. 23. No. 6. S. 637—643.
  18. Moxey P.W. et al. The BASIL survival prediction model in patients with peripheral arterial disease undergoing revascularization in a university hospital setting and comparison with the FINNVASC and modified PREVENT scores. Journal of vascular surgery. 2013. Vol. 57. No. 1. P. 1—7.
  19. Adam D.J. et al. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL): multicentre, randomised controlled trial. Lancet 2005;366:1925—34.
  20. Bradbury A.W. et al. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: a survival prediction model to facilitate clinical decision making. J Vasc Surg 2010;51(5 Suppl):52—68.

Copyright (c) 2019 Kasyanov B.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies