Infragenicular Bypass Graft for Limb Salvage Using Polytetrafluoroethylene and Distal Vein Cuff as the First Alternative in Patients Without Ipsilateral Greater Saphenous Vein

Aracil-Sanus, E.; Mendieta-Azcona, Covadonga; Cuesta-Gimeno, C.; Chinchilla-Molina, Antonio

doi:10.1007/s10016-004-0130-6

Cited by 18 publications

(5 citation statements)

References 37 publications

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“…Several strategies have been utilized to improve the performance and patency of prosthetic grafts. Some of these are: venous modi cations of the distal anastomosis (MOD) (10,11,12,5), heparin bonding at the luminal surface of PTFE grafts (Hb-ePTFE, Propaten; W.L. Gore & Associates, Inc.) (13,14), distal AV-stula ( 15) and grafts reinforced with rings (16).…”

Section: Resultsmentioning

confidence: 99%

Outcome of Infragenicular Prosthetic Grafts with and Without Distal Anastomotic Modification – A Retrospective Single Center Study

Setia

Yousefi

Samp

et al. 2021

Preprint

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Background: Peripheral revascularization with below-knee bypass (REBEL) utilizing prosthetic grafts demonstrate inferior patency and amputation-free survival rates, as compared to venous conduits. Because of improved hemodynamics, adding a venous modification to distal anastomoses in REBEL with prosthetic grafts is assumed to improve both patency and amputation-free survival. The aim of this study was to assess the performance of prosthetic grafts with and without venous modifications of the distal anastomosis (MOD) and compare the results with venous conduits, in terms of patency rates, amputation prevention and survival. Methods: The present single center retrospective, non-randomized observational study involved 221 REBEL in 201 patients. Data was collected by viewing hospital records and follow-up clinical and duplex ultrasound examinations (up to 48 months). For analysis, the patients were divided in 3 groups; REBEL using prosthetic grafts with MOD (PGY) or without (PGN) anastomotic modification and REBEL using plain venous conduits without anastomotic modifications (VG). Primary patency, assisted primary patency, secondary patency, amputation-free survival and overall survival was analyzed.Results: The median follow-up was 27 months. The most common site of distal anastomosis in PGY were the crural arteries (77.8%) and 50% of PGY patients had already undergone vein-harvesting for peripheral revascularization. Average duration of surgery for PGY was 284 minutes, >70 minutes more as compared to PGN (p=0,001). In PGY a statistically insignificant tendency to decreased primary and secondary patency rates as compared to PGN was observed at 12 and 36 months. PGY displayed a significant lower amputation-free survival rate at 12 and 48 months as compared to PGN (62.9% vs 87.6% and 43.4% vs 69.75%; p=0.038). Overall survival for the three groups was not different (p=0.375). Conclusion: To summarize, modification of the distal anastomotic site using venous cuff techniques did not result in improved patency or amputation prevention. Nonetheless, from a technical view of facilitating the creation of anastomoses between relatively rigid, large bore prosthetic grafts and calcified delicate small diameter infrapopliteal arteries, anastomotic modelling offers potential anatomic and hemodynamic advantages, thus improving outcome on long term follow up. However, prospective randomized studies are required to corroborate this hypothesis.

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Section: Resultsmentioning

confidence: 99%

Outcome of Infragenicular Prosthetic Grafts with and Without Distal Anastomotic Modification – A Retrospective Single Center Study

Setia

Yousefi

Samp

et al. 2021

Preprint

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“…This would alter the wall shear stress and reduce the stimulus for intimal hyperplasia. 10 , 13 , 14 Vein cuffs also may bring the following technical advantages: allow an easier anastomosis, particularly to small vessels 15 ; help preserve the outflow in the event of graft thrombosis 16 ; and provide a better compliance match between the vein and the recipient artery. 17 The most employed vein cuffs are the Miller cuff 18 and the St. Mary’s boot.…”

Section: Discussionmentioning

confidence: 99%

Tapered reinforced graft and vein cuff in the distal anastomosis as adjunct strategies for infrapopliteal prosthetic bypass graft in chronic limb-threatening ischemia: A case report

Dalio,

Gomes,

Bohatch Júnior

et al. 2023

SAGE Open Medical Case Reports

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The great saphenous vein is the optimal conduit for infrapopliteal bypass surgery in chronic limb-threatening ischemia. A prosthetic bypass graft is an acceptable option when the autologous vein is unavailable and the anatomy is not favorable for endovascular therapy. However, the low patency rate of prosthetic grafts calls for adjunct strategies to improve the outcomes. Tapered reinforced grafts and vein cuffs are proposed measures. We herein present a case of a 78-year-old man with chronic limb-threatening ischemia and an extensive necrotic lesion on the dorsum of the left foot. He was successfully treated with a prosthetic bypass using two adjunct strategies to help improve patency: a tapered reinforced graft and a vein cuff in the distal anastomosis. After debridement and partial skin grafting, the wound healed completely in 2 months. The bypass graft was patent for 1 year.

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“…22,23 For femorodistal reconstructions, including femorocrural anastomoses, the limb salvage rate is also comparable to other studies reporting about 55-68% after 3 to 5 years. [24][25][26] To prevent a graft infection, different procedures are used in vascular surgery. Regarding the materials used, grafts soaked with antibiotics have been employed with some success in the last 15 years.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic use of the silver-acetate–coated graft in arterial occlusive disease: A retrospective, comparative study

Larena-Avellaneda

Russmann

Fein

et al. 2009

Journal of Vascular Surgery

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The silver-coated prosthesis did not differ from standard materials. Silver had no significant effect on the risk of graft infection. Our study showed good results with the silver prosthesis in the aorto-iliaco-femoral position, but in cases of femorodistal grafting, a reduction of prosthetic infections was not achieved. The silver grafts did not prevent subsequent infections in cases of tissue loss or postoperative local complications.

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Infragenicular Bypass Graft for Limb Salvage Using Polytetrafluoroethylene and Distal Vein Cuff as the First Alternative in Patients Without Ipsilateral Greater Saphenous Vein

Cited by 18 publications

References 37 publications

Outcome of Infragenicular Prosthetic Grafts with and Without Distal Anastomotic Modification – A Retrospective Single Center Study

Outcome of Infragenicular Prosthetic Grafts with and Without Distal Anastomotic Modification – A Retrospective Single Center Study

Tapered reinforced graft and vein cuff in the distal anastomosis as adjunct strategies for infrapopliteal prosthetic bypass graft in chronic limb-threatening ischemia: A case report

Prophylactic use of the silver-acetate–coated graft in arterial occlusive disease: A retrospective, comparative study

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