Infrainguinal reconstructions: influence of surgical experience on outcome

Objectives: To evaluate the influence of surgical experience and operation technique on the outcome of infrainguinal reconstructions. Design: A longitudinal observational study of patients undergoing reconstructions to the popliteal and crural arteries. Setting: A regional hospital and an academic referral centre. Materials: 392 patients undergoing 442 reconstructions, 218 to the popliteal and 228 to the crural vessels. Chief outcome measures: Graft patency and leg salvage. Main results: At the popliteal level, 5-year patency after autogenous vein reconstruction was 76%. No difference was found between in situ and transposed vein reconstructions, but prosthetic reconstructions had a worse patency. At the crural level, 5-year patency for in situ vein, transposed vein and prosthetic bypass were 66, 55 and 21%, respectively. Corresponding leg salvage for chronic critical leg ischaemia was 91% with vein and 55% with prosthetic reconstruction at popliteal level, and 66 and 33% at the crural level. Surgical experience improved the outcome, as 3-year patency for in situ and transposed vein bypasses to the popliteal level were 82 and 95% for experienced surgeons, and 53 and 75% for less experienced surgeons. Corresponding leg salvage rates for reconstructions to the popliteal and crural levels were 85 and 67% for experienced surgeons, and 61 and 52% for less experienced surgeons. Conclusions: Outcome of infrainguinal reconstructions is influenced by the reconstruction level. Surgical experience and choice of the appropriate reconstruction technique can improve outcome.