Midterm Results of Autologous Saphenous Vein and ePTFE Pre-Cuffed Bypass Surgery in Peripheral Arterial Occlusive Disease

• Published in: Vascular and endovascular surgery 2011-10, Vol.45 (7), p.598-603
• Main Authors: Donker, J. M. W., Ho, G. H., te Slaa, A., de Groot, H. G. W., van der Waal, J. C. H., Veen, E. J., Laan, L. van der
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arterial Occlusive Diseases - physiopathology; Arterial Occlusive Diseases - surgery; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - instrumentation; Cardiology. Vascular system; Constriction, Pathologic; Female; Femoral Artery - physiopathology; Femoral Artery - surgery; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - physiopathology; Humans; Kaplan-Meier Estimate; Limb Salvage; Lower Extremity - blood supply; Male; Medical sciences; Middle Aged; Netherlands; Patient Selection; Polytetrafluoroethylene; Popliteal Artery - physiopathology; Popliteal Artery - surgery; Prosthesis Design; Retrospective Studies; Saphenous Vein - transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Transplantation, Autologous; Treatment Outcome; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/1538574411414923

Introduction: The graft of choice in lower limb bypass surgery is the autologous saphenous vein (ASV). However, a prosthetic graft is needed in the absence of an ASV. In such situations, we used an expanded polytetrafluoroethylene (ePTFE) pre-cuffed Dynaflo graft as supragenicular bypass or Distaflo graft as infragenicular or femorocrural bypass. In respect to the expanding possibilities of percutaneous transluminal angioplasty (PTA), the indication for bypass surgery moved toward patients with advanced stages of peripheral arterial occlusive disease. For this reason, this study analyzed the current performances of these ePTFE grafts and ASV grafts with special attention to limb salvage. Methods: In a retrospective study all patients who underwent peripheral bypass surgery between 2004 and 2008 were included. Kaplan-Meier curves were used to express primary patency, secondary patency, and limb salvage rates at 1 and 3 years. Log-rank tests were performed to compare graft types. Results: A total of 272 grafts (ePTFE/ASV: 110/162) were performed in lower limb bypass surgery. The mean follow-up was 20.3 months. The secondary 3-year patency rates were for (n=78) supragenicular grafts (ePTFE/ASV: 45%/94%)*, for (n=124) infragenicular grafts (24%/74%)*, and 70 for femorocrural grafts (26%/52%). Limb salvage after 3 years was 59% in the ePTFE group versus 78% in the ASV group* (*P < .05). Conclusion. In the current population of vascular patients where no PTA is possible and a peripheral bypass is necessary, the ASV remains the graft of first choice. However, the pre-cuffed ePTFE graft is a good alternative, especially in cases of critical limb ischemia, in respect to an acceptable limb salvage rate.