Comparison of long-term results of above-the-knee femoro-popliteal bypass with autogenous vein and polytetrafluoroethylene grafts

Abstract

PurposeTo analyze the long-term results of above-the-knee femoro-popliteal bypass (ATKFPB) with vein grafts compared with polytetrafluoroethylene (PTFE) grafts.MethodsA database of patients with chronic atherosclerotic occlusive disease who underwent ATKFPB was retrospectively reviewed. Characteristics of patient and arterial lesion, and follow-up results were compared between vein grafts and PTFE grafts. Graft patency was determined by periodic examinations of duplex ultrasonography or CT angiograms. Graft patency and limb salvage rates were calculated using the Kaplan-Meier method.ResultsIn total, 253 ATKFPBs (107 vein grafts; 146 PTFE grafts; critical limb ischemia, 32%) were performed on 228 patients (mean age, 68.5 years; male, 87.7%). No significant differences were observed between the two groups with respect to demographic characteristics, characteristics of arterial lesions, or distal runoff score. During the mean follow-up period of 41 months (range, 1-122 months), 14.5% patients died, and 94% of all limbs were available for follow-up. The primary patency rates were not significantly different between the two groups at 10 years after treatment (75% vs. 42%, P = 0.330). However, the primary-assisted patency rates (88% vs. 42%, P = 0.003) and secondary patency rates (91% vs. 49%, P = 0.013) were significantly higher in the vein grafts compared with the PTFE grafts. Graft occlusion developed more often in the PTFE grafts (5.6% vs. 20.5%, P = 0.001). When graft occlusion occurred, acute limb ischemia was significantly more frequent in the PTFE grafts than in the vein grafts (0% vs. 53%, P = 0.027).ConclusionAfter ATKFPB, autologous vein grafts showed significantly better long-term results compared with PTFE grafts.

Predictive factors for better bypass patency and limb salvage after prosthetic above-knee bypass reconstruction

“…For study design, we focused on large single-and multicenter, prospective randomized studies that have been conducted in this regard since 1980 to allow discussion of our results with regard to the findings of these published studies [2][3][4][5][6][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Supplementary Table, online only).…”

Vein Versus Prosthetic Graft for Femoropopliteal Bypass Above the Knee: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Higher patency rates of vein grafts have been noted previously. Heo et al 22 completed an analysis of 253 above-knee femoropopliteal bypass grafts and found that there were significantly higher primary assisted and secondary patency rates in the vein group at 10 years. They also showed that PTFE grafts have significantly higher rates of acute limb ischemia and a higher frequency of sudden occlusion.…”

“…They also showed that PTFE grafts have significantly higher rates of acute limb ischemia and a higher frequency of sudden occlusion. 22 On the other hand, vein graft occlusions tended to present as recurrent claudication, which may explain the higher rates of primary assisted patency and secondary patency. 22…”

Factors associated with long-term graft patency after lower extremity arterial bypasses

“…Many clinical studies have been conducted to determine risk factors of graft occlusion, which tested conduit materials, bypass procedures, indications for LEAB, coexisting disease, extent of the arterial lesion, presence of prior surgical or endovascular intervention, etc. [ 8 9 10 11 ]. Furthermore, we have known that the risk factors for limb loss are not only ischemic condition but also sites of the ischemic wound and presence of foot infection [ 12 ].…”