Autologous saphenous vein and heparin-bonded expanded polytetrafluoroethylene as graft materials for below-the-knee femoro-popliteal bypass in patients with critical limb ischemia: A propensity score-matched analysis

• Published in: The surgeon (Edinburgh) 2022-04, Vol.20 (2), p.85-93
• Main Authors: Dorigo, Walter, Fargion, Aaron, Bassoli, Giulia, Di Domenico, Rossella, Giacomelli, Elena, Piffaretti, Gabriele, Alessi Innocenti, Alessandro, Pratesi, Carlo
• Format: Article
• Language: English
• Subjects: Anticoagulants - therapeutic use; Autologous vein; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Case-Control Studies; Chronic Limb-Threatening Ischemia; Coated Materials, Biocompatible; Comparison; Critical limb ischemia; Heparin; Heparin bonded ePTFE; Humans; Infrainguinal bypass; Ischemia - surgery; Limb Salvage; Polytetrafluoroethylene; Propensity Score; Prosthesis Design; Retrospective Studies; Saphenous Vein - surgery; Saphenous Vein - transplantation; Treatment Outcome; Vascular Patency
• ISSN: 1479-666X; 2405-5840
• DOI: 10.1016/j.surge.2021.02.001

To compare the outcomes of heparin bonded expanded polytetrafluoroethylene (HePTFE) and autologous saphenous vein (ASV) in patients undergoing below-knee (BK) femoro-popliteal bypass for critical limb ischemia (CLI). Retrospective single-centre matched case–control study. From 2003 to 2019, 275 consecutive BK bypasses for CLI were performed, 109 with the ASV and 166 with a HePTFE graft. All the baseline characteristics that were reliably measured and were potentially relevant in the decision-making process were included as confounders in a logistic regression model and the factors that were significantly different between the two groups then used to perform a propensity matching analysis. Propensity score-based matching was performed in a 1:1 ratio to compare outcomes. Arterial hypertension, hyperlipemia, the need for tibial anastomosis at the distal level and the run-off status were the covariates included in the matching. Follow-up outcomes were estimated by Kaplan–Meier methods and compared with log rank test. After propensity matching, 101 HePTFE bypasses were matched with 101 ASV bypasses. The median duration of follow-up was 37 months (range 1–192). The 5-year survival rate was 67.5% (standard error (SE) 0.05) in the HePTFe group and 64.5% (SE 0.06) in the ASV group (p = 0.8, log rank 0.04). Primary patency rates were 38% (SE 0.06) in the HePTFE group and 41% (SE 0.06) in the ASV group (p = 0.7, log rank 0.3). Also assisted primary patency and secondary patency rates did not differ in the two groups. Amputation-free survival was 53% (SE 0.05) in the HePTFE group and 58% (SE 0.06) in the ASF group (p = 0.6, log rank 0.2). HePTFE provided 5-year similar results to those obtained with use of the ASV in equivalent patients with CLI undergoing below-knee or tibial bypass. •Retrospective single-centre matched case–control study•HePTFE and ASV were compared in CLI patients undergoing BK bypass•The two materials provided similar 5-years results in equivalent patients•HePTFE could be potentially used in all the patients without an optimal ASV•The authors support the need for new prospective RCTs