Ann Surg Treat Res.  2015 Jan;88(1):28-34. 10.4174/astr.2015.88.1.28.

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

Affiliations
  • 1Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ywkim@skku.edu

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.

Keyword

Comparative study; Vascular graft occlusion; Peripheral arterial occlusive disease

MeSH Terms

Extremities
Follow-Up Studies
Graft Occlusion, Vascular
Humans
Ischemia
Limb Salvage
Male
Polytetrafluoroethylene*
Retrospective Studies
Transplants*
Ultrasonography
Veins*
Polytetrafluoroethylene

Figure

  • Fig. 1 Comparison of patency rates between vein grafts and polytetrafluoroethylene (PTFE) grafts following above-the-knee femoro-popliteal bypass grafting.

  • Fig. 2 Comparison of cumulative limb salvage rates between the vein graft and the polytetrafluoroethylene (PTFE) graft groups following above-the-knee femoro-popliteal bypass grafting.

  • Fig. 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].


Cited by  1 articles

Factors associated with long-term graft patency after lower extremity arterial bypasses
Ki-Sang Jung, Seon-Hee Heo, Shin-Young Woo, Yang-Jin Park, Dong-Ik Kim, Young-Wook Kim
Ann Surg Treat Res. 2021;100(3):175-185.    doi: 10.4174/astr.2021.100.3.175.


Reference

1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007; 33:Suppl 1. S1–S75.
2. Bergan JJ, Veith FJ, Bernhard VM, Yao JS, Flinn WR, Gupta SK, et al. Randomization of autogenous vein and polytetrafluorethylene grafts in femoral-distal reconstruction. Surgery. 1982; 92:921–930.
3. Londrey GL, Ramsey DE, Hodgson KJ, Barkmeier LD, Sumner DS. Infrapopliteal bypass for severe ischemia: comparison of autogenous vein, composite, and prosthetic grafts. J Vasc Surg. 1991; 13:631–636.
4. Sayers RD, Raptis S, Berce M, Miller JH. Long-term results of femorotibial bypass with vein or polytetrafluoroethylene. Br J Surg. 1998; 85:934–938.
5. Abbott WM, Green RM, Matsumoto T, Wheeler JR, Miller N, Veith FJ, et al. Above-Knee Femoropopliteal Study Group. Prosthetic above-knee femoropopliteal bypass grafting: results of a multicenter randomized prospective trial. J Vasc Surg. 1997; 25:19–28.
6. AbuRahma AF, Robinson PA, Holt SM. Prospective controlled study of polytetrafluoroethylene versus saphenous vein in claudicant patients with bilateral above knee femoropopliteal bypasses. Surgery. 1999; 126:594–601.
7. Ballotta E, Renon L, Toffano M, Da Giau G. Prospective randomized study on bilateral above-knee femoropopliteal revascularization: polytetrafluoroethylene graft versus reversed saphenous vein. J Vasc Surg. 2003; 38:1051–1055.
8. Berglund J, Bjorck M, Elfstrom J. SWEDVASC Femoro-popliteal Study Group. Long-term results of above knee femoropopliteal bypass depend on indication for surgery and graft-material. Eur J Vasc Endovasc Surg. 2005; 29:412–418.
9. Burger DH, Kappetein AP, Van Bockel JH, Breslau PJ. A prospective randomized trial comparing vein with polytetrafluoroethylene in above-knee femoropopliteal bypass grafting. J Vasc Surg. 2000; 32:278–283.
10. Green RM, Abbott WM, Matsumoto T, Wheeler JR, Miller N, Veith FJ, et al. Prosthetic above-knee femoropopliteal bypass grafting: five-year results of a randomized trial. J Vasc Surg. 2000; 31:417–425.
11. Johnson WC, Lee KK. A comparative evaluation of polytetrafluoroethylene, umbilical vein, and saphenous vein bypass grafts for femoral-popliteal above-knee revascularization: a prospective randomized Department of Veterans Affairs cooperative study. J Vasc Surg. 2000; 32:268–277.
12. Klinkert P, Schepers A, Burger DH, van Bockel JH, Breslau PJ. Vein versus polytetrafluoroethylene in above-knee femoropopliteal bypass grafting: five-year results of a randomized controlled trial. J Vasc Surg. 2003; 37:149–155.
13. Klinkert P, Post PN, Breslau PJ, van Bockel JH. Saphenous vein versus PTFE for above-knee femoropopliteal bypass. A review of the literature. Eur J Vasc Endovasc Surg. 2004; 27:357–362.
14. Veith FJ, Gupta SK, Ascer E, White-Flores S, Samson RH, Scher LA, et al. Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions. J Vasc Surg. 1986; 3:104–114.
15. Jackson MR, Belott TP, Dickason T, Kaiser WJ, Modrall JG, Valentine RJ, et al. The consequences of a failed femoropopliteal bypass grafting: comparison of saphenous vein and PTFE grafts. J Vasc Surg. 2000; 32:498–504.
16. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997; 26:517–538.
17. Smolock CJ, Anaya-Ayala JE, Kaufman Y, Bavare CS, Patel MS, El-Sayed HF, et al. Current efficacy of open and endovascular interventions for advanced superficial femoral artery occlusive disease. J Vasc Surg. 2013; 58:1267–1275.e1-2.
18. Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366:1925–1934.
19. Tilanus HW, Obertop H, Van Urk H. Saphenous vein or PTFE for femoropopliteal bypass. A prospective randomized trial. Ann Surg. 1985; 202:780–782.
20. John TG, Stonebridge PA, Kelman J, Murie JA, Jenkins AM, Ruckley CV. Above-knee femoropopliteal bypass grafts and the consequences of graft failure. Ann R Coll Surg Engl. 1993; 75:257–260.
21. Pereira CE, Albers M, Romiti M, Brochado-Neto FC, Pereira CA. Meta-analysis of femoropopliteal bypass grafts for lower extremity arterial insufficiency. J Vasc Surg. 2006; 44:510–517.
22. Park KM, Park YJ, Yang SS, Kim DI, Kim YW. Treatment of failing vein grafts in patients who underwent lower extremity arterial bypass. J Korean Surg Soc. 2012; 83:307–315.
23. Poletti LF, Matsuura JH, Dattilo JB, Posner MP, Lee HM, Scouvart M, et al. Should vein be saved for future operations? A 15-year review of infrainguinal bypasses and the subsequent need for autogenous vein. Ann Vasc Surg. 1998; 12:143–147.
24. Sterpetti AV, Schultz RD, Feldhaus RJ, Peetz DJ Jr. Seven-year experience with polytetrafluoroethylene as above-knee femoropopliteal bypass graft. Is is worthwhile to preserve the autologous saphenous vein? J Vasc Surg. 1985; 2:907–912.
Full Text Links
  • ASTR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr