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

Heo SH, Park YJ, Woo SY, Kim DI, Kim YW - Ann Surg Treat Res (2014)

Bottom Line: No significant differences were observed between the two groups with respect to demographic characteristics, characteristics of arterial lesions, or distal runoff score.The primary patency rates were not significantly different between the two groups at 10 years after treatment (75% vs. 42%, P = 0.330).After ATKFPB, autologous vein grafts showed significantly better long-term results compared with PTFE grafts.

View Article: PubMed Central - PubMed

Affiliation: Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To analyze the long-term results of above-the-knee femoro-popliteal bypass (ATKFPB) with vein grafts compared with polytetrafluoroethylene (PTFE) grafts.

Methods: A 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.

Results: In 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).

Conclusion: After ATKFPB, autologous vein grafts showed significantly better long-term results compared with PTFE grafts.

No MeSH data available.


Related in: MedlinePlus

Diagnosis and treatment of a failing vein graft: (A) femoro-popliteal vein graft showing stenosis close to the site of proximal anastomosis on a contrast angiogram; (B) stenotic vein graft showing a high peak systolic velocity (451 cm/sec) on a duplex ultrasonography scan; (C) vein graft stenosis; and (D) vein patch angioplasty for the treatment of the failing graft [22].
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Figure 3: Diagnosis and treatment of a failing vein graft: (A) femoro-popliteal vein graft showing stenosis close to the site of proximal anastomosis on a contrast angiogram; (B) stenotic vein graft showing a high peak systolic velocity (451 cm/sec) on a duplex ultrasonography scan; (C) vein graft stenosis; and (D) vein patch angioplasty for the treatment of the failing graft [22].

Mentions: Given that SFA lesions that require ATKFPB are as not as diffuse or atherosclerotic as SFA lesions that require distal leg bypass grafting, it was not surprising that we observed a significant difference in the limb salvage rates between the two groups (Fig. 2). The clinical results of patients with graft occlusions also revealed that patients in the PTFE graft group exhibited poorer clinical outcomes, including a higher frequency of acute limb ischemia (0% vs. 53.3%, P = 0.027). The poorer late clinical outcomes of the PTFE grafts may be attributed to differences in biological impact on the surrounding native arteries from the autogenous vein graft. This hypothesis is supported by the higher frequency of sudden occlusion associated with PTFE graft (vein graft, 5.6% vs. PTFE graft, 20.5%; P = 0.001) and the more frequent graft narrowing in vein grafts (vein graft, 14.0% vs. PTFE graft, 2.1%; P < 0.001) (Fig. 3). These findings may be due to sudden thrombosis, which occurs more frequently in prosthetic grafts than in vein grafts, in which intimal hyperplasia is the major cause of late graft occlusion [20]. As reported in previous studies [15,21], rapid revascularization is required to manage the impact of sudden graft thrombosis on the local collateral circulation and the persistence of foreign graft material in tissues. Such events may lead to higher limb loss rates in cases of prosthetic graft occlusion compared with those of vein graft occlusion.


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

Heo SH, Park YJ, Woo SY, Kim DI, Kim YW - Ann Surg Treat Res (2014)

Diagnosis and treatment of a failing vein graft: (A) femoro-popliteal vein graft showing stenosis close to the site of proximal anastomosis on a contrast angiogram; (B) stenotic vein graft showing a high peak systolic velocity (451 cm/sec) on a duplex ultrasonography scan; (C) vein graft stenosis; and (D) vein patch angioplasty for the treatment of the failing graft [22].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4279987&req=5

Figure 3: Diagnosis and treatment of a failing vein graft: (A) femoro-popliteal vein graft showing stenosis close to the site of proximal anastomosis on a contrast angiogram; (B) stenotic vein graft showing a high peak systolic velocity (451 cm/sec) on a duplex ultrasonography scan; (C) vein graft stenosis; and (D) vein patch angioplasty for the treatment of the failing graft [22].
Mentions: Given that SFA lesions that require ATKFPB are as not as diffuse or atherosclerotic as SFA lesions that require distal leg bypass grafting, it was not surprising that we observed a significant difference in the limb salvage rates between the two groups (Fig. 2). The clinical results of patients with graft occlusions also revealed that patients in the PTFE graft group exhibited poorer clinical outcomes, including a higher frequency of acute limb ischemia (0% vs. 53.3%, P = 0.027). The poorer late clinical outcomes of the PTFE grafts may be attributed to differences in biological impact on the surrounding native arteries from the autogenous vein graft. This hypothesis is supported by the higher frequency of sudden occlusion associated with PTFE graft (vein graft, 5.6% vs. PTFE graft, 20.5%; P = 0.001) and the more frequent graft narrowing in vein grafts (vein graft, 14.0% vs. PTFE graft, 2.1%; P < 0.001) (Fig. 3). These findings may be due to sudden thrombosis, which occurs more frequently in prosthetic grafts than in vein grafts, in which intimal hyperplasia is the major cause of late graft occlusion [20]. As reported in previous studies [15,21], rapid revascularization is required to manage the impact of sudden graft thrombosis on the local collateral circulation and the persistence of foreign graft material in tissues. Such events may lead to higher limb loss rates in cases of prosthetic graft occlusion compared with those of vein graft occlusion.

Bottom Line: No significant differences were observed between the two groups with respect to demographic characteristics, characteristics of arterial lesions, or distal runoff score.The primary patency rates were not significantly different between the two groups at 10 years after treatment (75% vs. 42%, P = 0.330).After ATKFPB, autologous vein grafts showed significantly better long-term results compared with PTFE grafts.

View Article: PubMed Central - PubMed

Affiliation: Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To analyze the long-term results of above-the-knee femoro-popliteal bypass (ATKFPB) with vein grafts compared with polytetrafluoroethylene (PTFE) grafts.

Methods: A 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.

Results: In 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).

Conclusion: After ATKFPB, autologous vein grafts showed significantly better long-term results compared with PTFE grafts.

No MeSH data available.


Related in: MedlinePlus