Noninvasive predictors of patency for infrapopliteal PTFE bypasses with combined arteriovenous fistula and vein interposition technique

• Published in: The American journal of surgery 1995-08, Vol.170 (2), p.103-105
• Main Authors: Ascer, Enrico, Pollina, Robert M., Gennaro, Mark, Lorensen, Elke
• Format: Article
• Language: English
• Subjects: Aged; Arteriovenous Shunt, Surgical; Biological and medical sciences; Blood Vessel Prosthesis; Failure; Female; Fistula; Fistulae; Follow-Up Studies; Graft Occlusion, Vascular; Graft rejection; Grafting; Humans; Ischemia; Ischemia - diagnostic imaging; Ischemia - surgery; Leg - blood supply; Male; Medical sciences; Perfusion; Polytetrafluoroethylene; Predictions; Prostheses; Reoperation; Sensitivity and Specificity; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Velocity
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(99)80264-5

Background: Despite recent increased indications for infrapopliteal prosthetic bypass grafts with complementary arteriovenous fistulas, objective documentation of improved perfusion to the foot is lacking. In addition, the value of post-operative noninvasive testing in the prediction of bypass success remains unclear. Patients and methods: Over a 3-year period, 41 patients with limb-threatening ischemia were treated with 41 infrapopliteal 6-mm polytetrafluoroethylene (PTFE) bypasses with a complementary arteriovenous fistula at our institution. Twenty-four patients were men and 17 were women, with an average age of 71.3 ± 8.6 years. Thirty-one patients (76%) had undergone at least 1 previous failed ipsilateral arterial bypass. Preoperative and early postoperative (less than 1 month) pulse-volume recordings of transmetatarsal amplitude (TMA) were available for analysis in 28 patients. Postoperative duplex evaluations of graft velocity, fistula patency, and prograde distal arterial flow were performed in 26 of the original 41 patients. These data were correlated to early graft failure in an attempt to identify specific noninvasive predictors. Results: Cumulative primary patency rates of the original 41 patients were 79.0%, 69.2%, and 63.8% at 1, 2, and 3 years, respectively. The early postoperative TMA values ranged from 3 to 50 mm with a mean of 21.6 ± 14.8 mm ( P < 0.001). Twenty-one patients (75%) had patent grafts on follow-up of 2 to 37 months (mean 18.6). The early postoperative TMA in this group of patients was 26.5 ± 12.4 mm compared with 3.3 ± 2.8 mm in the 6 patients whose grafts failed within 6 months ( P < 0.001). A TMA of