Secondary graft patency

Secondary graft patency credits continued function of the original graft reconstruction, including qualifying restoration after an occlusion. It differs from assisted primary graft patency, which requires that patency never have been lost. The 1997 reporting standard limits what counts as salvaging the original reconstruction: a replacement that does not preserve the required original graft continuity is not simply a continuation of its secondary patency.^[ref]

Secondary patency is a durability endpoint that can credit successful salvage. It does not assert that blood flowed continuously during an interval in which the graft was occluded. An instantaneous graft patency assessment and a reconstructed follow-up history therefore need not be the same data object.

An original example follows five grafts through six months. One occludes at month 2 but is successfully reopened at month 3 with a qualifying salvage of the original reconstruction. Another occludes at month 4 and is not restored. The remaining three stay patent without procedures. At the end of this complete observation period, $4/5$ retain secondary patency while only $3/5$ have uninterrupted patency without a qualifying intervention. A newly created replacement bypass should be recorded under the stated reconstruction rules, rather than silently resetting the old graft’s clock.

A time-dependent analysis must define when secondary patency is considered irretrievably lost, how salvage episodes are adjudicated and what happens when follow-up ends before that status is resolved. Death can prevent later observation of graft failure; treating it as ordinary right censoring estimates a particular hypothetical durability quantity and requires assumptions. A real-world probability of failure before death instead calls for a competing risks analysis.

Reporting primary graft patency, assisted primary graft patency and secondary graft patency together makes the role of preventive and rescue interventions visible. The associated procedure counts, observation times and clinical outcomes remain necessary to distinguish prolonged graft function from the wider burden and consequences of maintaining it.