Factors affecting the patency of infrainguinal bypass

Abstract

Two hundred forty-nine well-characterized difficult distal bypasses, entered into a multicenter dextran 40 trial, were reevaluated after 3 years. Seventy in situ (IS) vein grafts, 49 reversed saphenous (RS) vein grafts, 60 polytetrafluoroethylene (PTFE) grafts, and 70 umbilical vein (UV) grafts were used. Primary and secondary patency rates at 3 years were, respectively, 84% and 90% for IS, 66% and 73% for RS, 35% and 48% for PTFE, and 24% and 32% for UV. Subgroup analysis according to the site of distal anastomosis showed no significant differences in primary patency among these grafts at the above-knee level but significant differences between both vein grafts (IS and RV) and the others (PTFE and UV) below the knee (78% vs 31%, respectively). This difference increased at the tibial level (78% vs 10%) but there was also a significant difference between IS grafts (88%) and RS grafts (63%) at this level. Hazard functional analysis showed all grafts except IS grafts begin to fail at an increasing rate again by 24 months. Although overall results appeared to favor PTFE over UV, 62% of PTFE vs 16% of UV terminated at the above-knee level and the patency results of these two grafts were not significantly different at any level. The only other factor than graft type and distal anastomotic site that consistently correlated with late patency was tobacco use. Diabetic patients actually fared significantly better than nondiabetic patients, presumably because of the higher use of IS grafts and lower use of tobacco. The choice of graft overshadows all other factors affecting patency and its influence is magnified with more distal terminal anastomosis.

Platelet Deposition on ePTFE Grafts Coated with Fibrin Glue with or without FGF-1 and Heparin

“…The disappointing long-term patency reconstructive procedures, expanded polytetrafluoroof small-caliber prosthetic grafts may be due in part ethylene (ePTFE) grafts show high early and late failto early thrombogenicity of the prosthetic surface. We ure rates [1][2][3][4] that are in part related to the inherent previously reported that the coating of expanded polythrombogenicity of the graft-blood interface. …”

Surgical treatment of lower limb ischemia in diabetic patients – long-term results

“…A significant difference was reported between RSV and the PTFE grafts below the knee level. However, the only factor other than graft type and distal anastomotic site that consistently correlated with late patency was tobacco use [18]. In this study anastomosis sites were all below the knee level and graft material was reversed saphenous vein for all patients.…”

Der supragenuale femoropopliteale Bypass – Vene vs. Gefäßprothese

“…Zahlreiche retrospektive Erhebungen und einige prospektive Studien haben den Nachweis erbracht, daß die Offenheitsraten kniegelenküberschreitender Rekonstruktionen mit der körpereigenen V. saphena magna signifikant höher sind als solche mit alloplastischem Bypassmaterial [4,6,7,10,13,14]. Demgegenüber gibt es nur wenige Publikationen, die sich mit vergleichenden Untersuchungen bezüglich der Offenheitsraten von Venen-und Kunststoffbypasses bei supragenualen Rekonstruktionen befassen.…”