Meta-analysis of polytetrafluoroethylene bypass grafts to infrapopliteal arteries1 1Competition of interest: none.Additional material for this article may be found online at www.mosby.com/jvs.

Albers, Maximiano; Battistella, Vinicius Marcus; Romiti, Marcello; Rodrigues, Alfredo Augusto Eyer; Pereira, Carlos Alberto de Bragança

doi:10.1016/s0741-5214(02)75332-9

Cited by 112 publications

(22 citation statements)

References 64 publications

(133 reference statements)

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“…Autologous vein bypass grafts, the gold-standard of care, cannot always be harvested, prompting the use of prosthetic vascular grafts. However, prosthetic vascular grafts have poor long-term patency, particularly when used in small diameter applications [1,2]. Therefore, there remains an urgent need for safe and effective materials for the fabrication of vascular grafts.…”

Section: Introductionmentioning

confidence: 99%

The blood and vascular cell compatibility of heparin-modified ePTFE vascular grafts

et al. 2013

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Prosthetic vascular grafts do not mimic the antithrombogenic properties of native blood vessels and therefore have higher rates of complications that involve thrombosis and restenosis. We developed an approach for grafting bioactive heparin, a potent anticoagulant glycosaminoglycan, to the lumen of ePTFE vascular grafts to improve their interactions with blood and vascular cells. Heparin was bound to aminated poly(1,8-octanediol-co-citrate) (POC) via its carboxyl functional groups onto POC-modified ePTFE grafts. The bioactivity and stability of the POC-immobilized heparin (POC–Heparin) were characterized via platelet adhesion and clotting assays. The effects of POC–Heparin on the adhesion, viability and phenotype of primary endothelial cells (EC), blood outgrowth endothelial cells (BOECs) obtained from endothelial progenitor cells (EPCs) isolated from human peripheral blood, and smooth muscle cells were also investigated. POC–Heparin grafts maintained bioactivity under physiologically relevant conditions in vitro for at least one month. Specifically, POC–Heparin-coated ePTFE grafts significantly reduced platelet adhesion and inhibited whole blood clotting kinetics. POC–Heparin supported EC and BOEC adhesion, viability, proliferation, NO production, and expression of endothelial cell-specific markers von Willebrand factor (vWF) and vascular endothelial-cadherin (VE-cadherin). Smooth muscle cells cultured on POC–Heparin showed increased expression of α-actin and decreased cell proliferation. This approach can be easily adapted to modify other blood contacting devices such as stents where antithrombogenicity and improved endothelialization are desirable properties.

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Section: Introductionmentioning

confidence: 99%

The blood and vascular cell compatibility of heparin-modified ePTFE vascular grafts

et al. 2013

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“…5 - 7 Unfortunately, longer prosthetic grafts do not always perform as well as noted in several retrospective series. 8-10 …”

Section: Introductionmentioning

confidence: 99%

Comparison of Graft Patency, Limb Salvage, and Antithrombotic Therapy Between Prosthetic and Autogenous Below-Knee Bypass for Critical Limb Ischemia

Suckow

Kraiss

Stone

et al. 2013

Annals of Vascular Surgery

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Background The autogenous vein is the preferred conduit in below-knee vascular reconstructions. However, many argue that prosthetic grafts can perform well in crural bypass with adjunctive antithrombotic therapy. We therefore compared outcomes of below-knee prosthetic versus autologous vein bypass grafts for critical limb ischemia and the use of adjunctive antithrombotic therapy in both settings. Methods Utilizing the registry of the Vascular Study Group of New England (2003–2009), we studied 1227 patients who underwent below-knee bypass for critical limb ischemia, 223 of whom received a prosthetic graft to the below-knee popliteal artery (70%) or more distal target (30%). We used propensity matching to identify a patient cohort receiving single-segment saphenous vein yet had remained similar to the prosthetic cohort in terms of characteristics, graft origin/target, and antithrombotic regimen. Main outcome measures were graft patency and major limb amputation within 1 year. Secondary outcomes were bleeding complications (reoperation or transfusion) and mortality. We performed comparisons by conduit type and by antithrombotic therapy. Results Patients receiving prosthetic conduit were more likely to be treated with warfarin than those with greater saphenous vein (57% vs. 24%, P < 0.001). After propensity score matching, we found no significant difference in primary graft patency (72% vs. 73%, P = 0.81) or major amputation rates (17% vs. 13%, P = 0.31) between prosthetic and single-segment saphenous vein grafts. In a subanalysis of grafts to tibial versus popliteal targets, we noted equivalent primary patency and amputation rates between prosthetic and venous conduits. Whereas overall 1-year prosthetic graft patency rates varied from 51% (aspirin + clopidogrel) to 78% (aspirin + warfarin), no significant differences were seen in primary patency or major amputation rates by antithrombotic therapy (P = 0.32 and 0.17, respectively). Further, the incidence of bleeding complications and 1-year mortality did not differ by conduit type or antithrombotic regimen in the propensity-matched analysis. Conclusions Although limited in size, our study demonstrates that, with appropriate patient selection and antithrombotic therapy, 1-year outcomes for below-knee prosthetic bypass grafting can be comparable to those for greater saphenous vein conduit.

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“…Arm veins or polytetrafluoroethylene (PTFE) grafts with adjunctive procedures could be considered as alternative bypass conduits when all saphenous veins are inadequate for LEAB bypass [18]. Previous studies showed that results from infrapopliteal bypass using prosthetic graft have been less satisfactory than those obtained with arm vein (Table 4) [8,12,16,19–25].…”

Section: Discussionmentioning

confidence: 99%

“…In our study, subanalysis of infrapopliteal arm vein bypasses (23 cases) showed that 3-year primary patency, secondary patency, and limb salvage rates were 50.5%, 63.3%, 92.9%, respectively. By comparison, a meta-analysis of PTFE infrapopliteal bypass published in 2003 introduced 3-year primary patency, secondary patency, and limb salvage rates of 41%, 51%, and 66%, respectively [18]. The above results suggest that the arm vein is a favorable alternative conduit in infrapopliteal bypass when no saphenous veins are available.…”

Section: Discussionmentioning

confidence: 99%

Lower Extremity Arterial Bypass with Arm Vein Conduits and Literature Review

Park

Yoon

et al. 2016

VSI

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Purpose:The superiority of autogenous vein conduits is well known in lower extremity arterial bypass (LEAB). Among various alternative conduits for LEAB, long-term results of arm vein grafts were investigated in this study.Materials and Methods:We retrospectively reviewed clinical characteristics of 28 patients who underwent infrainguinal LEAB with autogenous arm vein grafts at a single institute between January 2003 and December 2015. All procedures were performed in the absence of adequate saphenous veins. Graft patency was determined by periodic examinations with duplex ultrasonography.Results:Autologous arm vein grafts were implanted for 28 patients (mean age, 60.4±16.8 years; range, 20–82 years; male, 92.9%; atherosclerosis, 19 [67.9%]; and non-atherosclerotic disease 9 [32.1%] including 5 patients with Buerger’s disease). Source of arm vein were basilic 13 (46.4%), cephalic 4 (14.3%) and composition graft with other veins in 11 (39.3%) cases. The level of distal anastomosis was distributed as popliteal in 5 (17.9%), tibio-peroneal in 21 (75.0%) and inframalleolar artery in 2 (7.1%) cases. Mean duration of follow-up was 41.5±46.9 months (range, 1–138 months). Cumulative primary patency rates at 1, 3, and 5 years were 66.5%, 60.9% and 60.9%, respectively. Assisted-primary patency rates at 1, 3 and 5 years were 66.5%, 66.5% and 66.5%, respectively. Secondary patency rates at 1, 3 and 5 years were 70.8%, 70.8% and 70.8%, respectively. There was one limb amputation during the follow-up period.Conclusion:Arm veins are a useful alternative conduit when great saphenous veins are not available during LEAB.

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Meta-analysis of polytetrafluoroethylene bypass grafts to infrapopliteal arteries1 1Competition of interest: none.Additional material for this article may be found online at www.mosby.com/jvs.

Abstract: This meta-analysis indicated moderate success for PTFE bypass grafts to infrapopliteal arteries, but the role of adjunctive procedures at the distal anastomosis remains uncertain.

Cited by 112 publications

References 64 publications

The blood and vascular cell compatibility of heparin-modified ePTFE vascular grafts

The blood and vascular cell compatibility of heparin-modified ePTFE vascular grafts

Comparison of Graft Patency, Limb Salvage, and Antithrombotic Therapy Between Prosthetic and Autogenous Below-Knee Bypass for Critical Limb Ischemia

Lower Extremity Arterial Bypass with Arm Vein Conduits and Literature Review

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