Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions

Abstract

Autologous saphenous vein (ASV) and polytetrafluoroethylene (PTFE) grafts were compared in 845 infrainguinal bypass operations, 485 to the popliteal artery and 360 to infrapopliteal arteries. Life-table primary patency rates for randomized PTFE grafts to the popliteal artery paralleled those for randomized ASV grafts to the same level for 2 years and then became significantly different (4-year patency rate of 68% +/- 8% [SE] for ASV vs. 47% +/- 9% for PTFE, p less than 0.025). Four-year patency differences for randomized above-knee grafts were not statistically significant (61% +/- 12% for ASV vs. 38% +/- 13% for PTFE, p greater than 0.25) but were for randomized below-knee grafts (76% +/- 9% for ASV vs. 54% +/- 11% for PTFE, p less than 0.05). Four-year limb salvage rates after bypasses to the popliteal artery to control critical ischemia did not differ for the two types of randomized grafts (75% +/- 10% for ASV vs. 70% +/- 10% for PTFE, p greater than 0.25). Although primary patency rates for randomized and obligatory PTFE grafts to the popliteal artery were significantly different (p less than 0.025), 4-year limb salvage rates were not (70% +/- 10% vs. 68% +/- 20%, p greater than 0.25). Primary patency rates at 4 years for infrapopliteal bypasses with randomized ASV were significantly better than those with randomized PTFE (49% +/- 10% vs. 12% +/- 7%, p less than 0.001). Limb salvage rates at 3 1/2 years for infrapopliteal bypasses with both randomized grafts (57% +/- 10% for ASV and 61% +/- 10% for PTFE) were better than those for obligatory infrapopliteal PTFE grafts (38% +/- 11%, p less than 0.01). These results fail to support the routine preferential use of PTFE grafts for either femoropopliteal or more distal bypasses. However, this graft may be used preferentially in selected poor-risk patients for femoropopliteal bypasses, particularly those that do not cross the knee. Although every effort should be made to use ASV for infrapopliteal bypasses, a PTFE distal bypass is a better option than a primary major amputation.

Lower Limb Revascularization with a New Bioactive Prosthetic Graft: Early and Late Results

“…3 If one excludes technical errors and the progression of atherosclerosis in inflow and outflow vessels, the main cause of early graft thrombosis is an intrinsic graft thrombogenicity, whereas anastomotic myointimal hyperplasia in most cases leads to late failure of the revascularization. 4 As a consequence, the reduction of graft thrombogenicity and the inhibition of neointimal formation seems to represent a logical strategy to prevent early and late graft thrombosis.…”

Desarrollo de un sistema de telemetría para el seguimiento postoperatorio de procedimientos en cirugía vascular: modelo in vitro

“…En el caso de las revascularizaciones mediante un bypass con vena safena a una arteria infrapoplítea, la tasa de permeabilidad primaria a 5 años disminuye a un 49% y hasta un 12% si se realiza con material protésico (21) . La figura 3 muestra la anastomosis distal de un bypass distal realizado con vena safena.…”

Classificação angiográfica na revascularização do membro inferior isquêmico: pode a angiografia definir a resistência do leito receptor do enxerto?

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IntroduçãoAs revascularizações dos membros inferiores isquê-micos apresentam indicações clínicas e técnicas operatóri-as já bastante estudadas e definidas [1][2][3][4] . Entretanto, metade destas intervenções pode falhar após 1 ano de acompanhamento clínico 1,5,6 .

A definição das características do leito distal a ser revascularizado pode nos auxiliar no estabelecimento da melhor estratégia terapêutica e representa uma etapa importantíssima na indicação do tipo de tratamento e da estratégia cirúrgica a ser seguida.

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