Adjuncts to Improve Patency of Infrainguinal Prosthetic Bypass Grafts

Abstract

The superiority of autologous venous conduit for infrainguinal arterial bypass has been well documented, especially when the bypass extends below the knee or to the tibial arteries. Nevertheless, when adequate autologous vein is not available, prosthetic bypasses (eg, polytetrafluoroethylene [PTFE] or Dacron) are often used in limb-salvage situations. The inferior long-term patency of these infrainguinal prosthetic bypasses has been documented by a number of studies. One such study reported a prospective multicenter randomized trial with only a 12% primary patency for infrapopliteal prosthetic bypasses after 4 years. Another study reported a similar experience with infragenicular bypasses with PTFE for limb salvage even for above-knee (27%, 5 year) and below-knee (25%, 5 year) femoral-popliteal bypasses. The reported PTFE graft patency was consistently inferior to that achieved with autologous vein for limb salvage. Dacron grafts appear to have similar patency rates to PTFE. In an attempt to improve prosthetic graft patency, a number of surgical and medical adjuncts have been developed. In this review, the authors discuss these adjuncts and their impact on infrainguinal prosthetic graft patency.

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

“…Although no specific societal recommendations exist in this regard, 27 our findings show that reasonable outcomes may be achieved for less-than-optimal lower extremity bypass grafts for a duration of at least 1 year.…”

Midterm results from a multicenter registry on the treatment of infrainguinal critical limb ischemia using a heparin-bonded ePTFE graft

“…Moreover, the need for adjunctive procedures at distal anastomotic sites was associated with poorer periop- erative patency rates. 19 In our series, adjunctive distal procedures were used more frequently in patients with poor runoff status, with severe clinical conditions (grade 5 and 6 of Rutherford's classification), and in reinterventions. Median duration of follow-up in our registry was 25.5 months, which is similar to the recent study from Daenens et al 20 Our estimated 36-months survival rate (83%) might seem high, considering the poor clinical condition of our patients.…”

Prosthetic Grafting and Arteriovenous Fistula for the Surgical Management of a Common Femoral Vein Injury Using a Staged Approach

“…To increase long-term PTFE graft patency, we added an AV fistula to the PTFE interposition site of the femoral vein. Several techniques can be used to increase prosthetic graft patency, such as vein cuffs, vein patches, and AV fistulae [8]. Richardson et al [9] reported the results of temporary AV fistulae for the management of traumatic venous injuries of the lower extremity in 8 patients, and noninvasive Doppler studies performed in 4 of the 8 patients at 3 to 8 months post-repair revealed no evidence of deep venous obstruction [9].…”