the Risks and Success Rates of Vascular Grafting Surgery

Regarding artificial vascular surgery?

I would like to inquire about the risks associated with the placement of an artificial blood vessel from the shoulder to the leg due to peripheral vascular occlusion (specifically, blockage of the major arteries from the abdomen to the legs).
The patient is a long-term dialysis patient who underwent heart bypass surgery and valve replacement seven years ago.
What is the level of risk, the success rate, and which major hospitals in Taipei currently perform this type of surgery?

fen, 40~49 year old female. Ask Date: 2010/01/24

Dr. Hou Shouxian reply Surgery

The surgical risks depend on the patient's health status (such as heart disease, post-bypass surgery, and post-valve replacement surgery, renal failure, and long-term dialysis), age, functional ability, and the presence of other chronic diseases.
Generally, the inherent risk of the surgery itself is less than 1%.
However, due to the need for general anesthesia, the estimated perioperative risk may range from 0% to 3%.
The success of the surgery relies on establishing a patent artificial vascular access, which depends on whether blood flow is unobstructed or if thrombosis occurs in the artificial vessel.
Typically, the patency rate of the artificial vessel one year post-surgery may be around 90-95%, and three years post-surgery may be approximately 70-85%.
Medical centers in Taipei and larger regional hospitals with cardiovascular surgery capabilities should be equipped to perform this type of surgery.

Reply Date: 2010/01/24

More Info

Vascular grafting surgery, particularly for patients with peripheral artery disease (PAD), carries specific risks and success rates that are influenced by various factors, including the patient's overall health, the extent of vascular disease, and previous medical history. In your case, the patient has a history of long-term dialysis and has undergone heart bypass surgery with valve replacement, which adds complexity to the surgical risk assessment.

Risks of Vascular Grafting Surgery
1. General Surgical Risks: Any surgical procedure, especially one requiring general anesthesia, carries inherent risks. These include complications such as bleeding, infection, and adverse reactions to anesthesia. For vascular grafting, the perioperative risk can range from 0% to 3%, depending on the patient's health status.

2. Specific Risks for High-Risk Patients: Given the patient's history of chronic kidney disease and prior cardiac surgery, the risks are heightened. Patients with renal failure may have impaired healing and increased susceptibility to infections. Additionally, the history of heart surgery suggests potential cardiovascular complications during or after the procedure, such as heart attack or stroke.

3. Graft-Specific Risks: The success of the graft itself can be influenced by factors such as thrombosis (blood clots), which can lead to graft failure. The patency rates (the likelihood that the graft remains open) are generally favorable, with one-year patency rates ranging from 90% to 95%, and three-year rates between 70% and 85%. However, these rates can be lower in patients with significant comorbidities.

Success Rates
The success rates of vascular grafting surgeries can be quite favorable, especially in patients without significant comorbid conditions. For your patient, the success of the graft will depend on several factors:
- Quality of the Graft: The type of graft used (synthetic vs. autologous) can impact outcomes. Synthetic grafts are often used for long segments, while autologous veins are preferred when available.

- Patient Compliance: Post-operative care, including medication adherence (such as antiplatelet therapy), lifestyle modifications, and regular follow-ups, plays a crucial role in the long-term success of the graft.

- Monitoring and Management of Comorbidities: Effective management of underlying conditions, such as diabetes and hypertension, is essential for improving outcomes.

Availability of Surgical Services in Taipei
In Taipei, many major hospitals and medical centers are equipped to perform vascular grafting surgeries. Institutions with specialized vascular surgery departments are likely to have the necessary expertise and resources. It is advisable to consult with a vascular surgeon who can provide a comprehensive evaluation and discuss the specific risks and benefits tailored to the patient's condition.

Conclusion
In summary, while vascular grafting surgery can be a life-saving procedure for patients with peripheral artery disease, it is not without risks, especially for those with significant comorbidities such as chronic kidney disease and a history of cardiac surgery. The success rates are generally high, but individual outcomes can vary based on multiple factors. It is crucial for the patient to have a thorough discussion with their healthcare provider to understand the specific risks and to make an informed decision regarding the surgery. Regular follow-up and adherence to post-operative care are vital for ensuring the best possible outcomes.

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