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peripheral artery bypass

Indications: - peripheral vascular disease - peripheral artery disease refractory to medical therapy Procedure: - prosthetic or vein grafts - prosthetic grafts associated with higher failure rate [2] Complications: - 30-day unplanned readmission rate 18%, many due to post-operative infections [4] Management: 1) aspirin 325 mg QD (after surgery) 2) addition of warfarin to aspirin associated with increased morbidity from hemorrhage & overall mortality 3) dual antiplatelet therapy (aspirin plus cloidogrel) a) more harm than benefit relative to aspirin alone for venous grafts b) may have benefits for prosthetic grafts [2]

General

arterial bypass graft; bypass surgery lower extremity revascularization

References

  1. Journal Watch 22(9):69, 2002 Johnson WC, Williford WO et al, Hemorrhagic complications during long-term postoperative warfarin administration in patients undergoing lower extremity arterial bypass surgery. J Vasc Surg 35:413, 2002 PMID: 15895759
  2. Belch JJF et al. Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial. J Vasc Surg 2010 Oct; 52:825 PMID: 20678878
  3. Lee CJ Infrapopliteal Bypass Technique. Medscape. April 11, 2017 http://emedicine.medscape.com/article/1895511-technique
  4. Secemsky EA, Schermerhorn M, Carroll BJ et al Readmissions After Revascularization Procedures for Peripheral Arterial Disease: A Nationwide Cohort Study. Ann Intern Med. 2017;1-8. PMID: 29204656 http://annals.org/aim/article-abstract/2665039/readmissions-after-revascularization-procedures-peripheral-arterial-disease-nationwide-cohort-study