Comparison of Surgical Outcomes between Reversed Vein Graft and Prosthetic Graft in Above-knee Femoropopliteal Bypass

Kim, Jong yeol; Kim, Young wook; Huh, Seung; Nah, Mok chan

Abstract

PURPOSE: Though it has been well known that the autologous vein graft is conduit of choice for infragenicular leg artery bypass, it is still less clear for above-knee femoro-popliteal artery bypass. We attempted to evaluate the outcomes of reversed saphenous vein graft in comparison with polytetrafluoroethylene (PTFE) graft in above-knee femoro-popliteal bypasses for the patients with chronic arterial occlusive disease. METHOD: In a period of 7 years and 9 months, 108 above-knee femoro-popliteal bypasses were performed in 96 patients (91 male, 5 female, mean age 67.3 years). The indications for bypass operation were short distance claudication in 54 (50%), rest pain in 36 (33%), and toe, foot ulcer or gangrene in 18 (17%) limbs. As bypass conduit, autologous reversed saphenous vein was used in 67 limbs, and PTFE graft in 41 limbs. We compared early (<30 days) postoperative complications, primary patency rates of grafts, and late outcomes of the limbs with proven graft occlusion between 2 patients groups (vein graft group vs. PTFE graft group). Primary cumulative graft patency rate were determined by Kaplan Meier method and compared them with log-rank test. RESULT: Early postoperative complications were not significantly different between two groups. During the follow-up period, 20 (18.5%) grafts were lost to follow-up and 14 patients were dead. Primary cumulative patency rates at 1, 3, 5 years were 97.44 +/- 2.53%, 91.11 +/- 4.94%, and 75.92 +/- 14.46% for vein grafts and 81.76 +/- 7.49%, 36.15 +/- 13.42, and 36.15 +/- 13.42% for PTFE grafts respectively.
CONCLUSION
In the patients underwent autologous vein graft for above-knee femoro-popliteal bypass, we experienced significantly better long-term patency, less serious surgical complication and less severe recurrent ischemic symptom after graft occlusion than in patients with PTFE graft.