P-094 - EFFICACY OF VASCULAR CLAMPING VS TOURNIQUET DURING INFRAPOPLITEAL ARTERIAL BYPASS

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Haga M. (Tokyo Medical University Hachioji Medical Center ~ Tokyo ~ Japan) , Nitta J. (Tokyo Medical University Hachioji Medical Center ~ Tokyo ~ Japan) , Kimura M. (Tokyo Medical University Hachioji Medical Center ~ Tokyo ~ Japan) , Motohashi S. (Tokyo Medical University Hachioji Medical Center ~ Tokyo ~ Japan) , Inoue H. (Tokyo Medical University Hachioji Medical Center ~ Tokyo ~ Japan) , Akasaka J. (Tokyo Medical University Hachioji Medical Center ~ Tokyo ~ Japan)
Introduction:
Vascular clamping during infrapopliteal arterial bypass (IAB) may cause local intimal injury to the vessel, while the use of a tourniquet may result in poor control of calcified vessels, which may lead to tissue ischemia and subsequent morbidity.1, 2 The superiority of one technique to the other remains unclear and even controversial. Therefore, the purpose of this study was to evaluate the efficacy of vascular clamping vs tourniquet during IAB.
Methods:
This retrospective, single-centre, observational study included patients with chronic limb-threatening ischemia undergoing IAB in our hospital between 2010 and 2020. These patients underwent IAB with vascular clamping or with a tourniquet and inflow occlusion. The first-line strategy during anastomosis was the use of a tourniquet. If a tourniquet could not be used due to severe calcification, vascular clamping was performed. The type of IAB, severe calcification, target vessel ischemia time, blood loss, overall operative time, complications, and length of hospital stay in the two groups were analysed. Limb-based patency and amputation-free survival were assessed using the Kaplan-Meier estimator and compared using the log-rank test.
Results:
A total of 102 patients, 32 in the clamping group and 70 in the tourniquet group, underwent IAB during the study period. The mean follow-up time was 46.7 ± 39.0 months. The clamping group had significantly higher rates of severe calcification than the tourniquet group (78.1 ± 42.0% vs 47.1 ± 50.2%; P < 0.001). Sixteen (50%) of the 32 patients in the clamping group initially underwent IAB with a tourniquet but required clamping to achieve complete haemostasis. There were no instances of neurologic deficits, thrombosis of distal vessels, or vascular injury in either group. Significantly lower blood loss was observed in the clamping group than in the tourniquet group (138.6 ± 101.7 vs 172.2 ± 155.6 mL; P = 0.03). However, there were no statistically significant differences between the two groups in terms of target vessel ischemia time (33.1 ± 14.2 vs 33.9 ± 10.9 min; P = 0.70), overall operative time (305.9 ± 77.0 vs 283.1 ± 66.6 min; P = 0.44), or length of hospital stay (30.6 ± 23.9 vs 29.8 ± 22.1 days; P = 0.68). Likewise, no statistically significant differences were observed in terms of limb-based patency or amputation-free survival (P = 0.55 and P = 0.76, respectively).
Conclusion:
Vascular clamping during IAB can significantly reduce blood loss. However, it is not superior to the tourniquet technique in terms of other operative and post-operative parameters, such as total operative time, complications, and length of hospital stay. Moreover, the two techniques lead to comparable long-term outcomes, including limb-based patency and amputation-free survival.
References:
1. Ciervo A, Dardik H, Qin F, Silvestri F, Wolodiger F, Hastings B, et al. The tourniquet revisited as an adjunct to lower limb revascularization. J Vasc Surg. 2000;31(3):436-42. 2. Wagner WH, Treiman RL, Cossman DV, Cohen JL, Foran RF, Treiman GS, et al. Tourniquet occlusion technique for tibial artery reconstruction. J Vasc Surg. 1993;18(4):637-45; discussion 45-7.