Comparison of Long-term Outcomes of Heparin Bonded Polytetrafluoroethylene and Autologous Vein Below Knee Femoropopliteal Bypasses in Patients with Critical Limb Ischaemia

Autor: Carolin Hock, Ingolf Töpel, Markus Steinbauer, C. Uhl, C. Grosch
Rok vydání: 2017
Předmět:
Male
Time Factors
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
chemistry.chemical_compound
0302 clinical medicine
Coated Materials
Biocompatible
Ischemia
Risk Factors
Popliteal Artery
030212 general & internal medicine
Polytetrafluoroethylene
Aged
80 and over
Gangrene
Critical limb ischaemia
Heparin
Middle Aged
Limb Salvage
Femoral Artery
Treatment Outcome
medicine.anatomical_structure
Lower Extremity
Bypass surgery
Anesthesia
Female
Cardiology and Cardiovascular Medicine
medicine.drug
medicine.medical_specialty
Critical Illness
Prosthesis Design
Transplantation
Autologous
Amputation
Surgical
Disease-Free Survival
Veins
Blood Vessel Prosthesis Implantation
Peripheral Arterial Disease
03 medical and health sciences
medicine.artery
Autologous vein
medicine
Humans
Vein
Vascular Patency
Aged
Proportional Hazards Models
Retrospective Studies
business.industry
Anticoagulants
medicine.disease
Popliteal artery
Blood Vessel Prosthesis
Surgery
chemistry
business
Zdroj: European Journal of Vascular and Endovascular Surgery. 54:203-211
ISSN: 1078-5884
DOI: 10.1016/j.ejvs.2017.05.001
Popis: Objective/Background Endovascular first is the preferred therapy approach to critical limb ischaemia (CLI). However, in spite of new endovascular techniques, bypass surgery still plays an important role, especially in patients with complex anatomy in whom endovascular therapy is not considered feasible, or has failed. The goal of this study was to analyse the outcomes of prosthetic or autologous vein for femoropopliteal (P3) bypasses performed under the abovementioned conditions. Methods A retrospective analysis of patients who underwent a femoropopliteal (P3) bypass for CLI (March 2007–December 2015) was conducted. Endovascular therapy was not possible. Patency rates, limb salvage, major adverse limb event (MALE) free survival, and survival after 5 years were analysed. Results In total, 151 cases were included in the analysis (rest pain 35.8%, ulcer/gangrene 64.3%). The graft material was autologous vein in 76 cases (vein group) and heparin bonded expanded polytetrafluoroethylene (HePTFE) in 75 cases (HePTFE group). Indications, risk factors, previous revascularisation procedures, and runoff vessels were similar in both groups. Thirty day mortality was 6.6% in the vein group and 5.3% in the HePTFE group ( p = .508), early graft occlusion (6.6% vs. 5.3%; p = .508) and 30 day major amputation rate (0% vs. 2.7%; p = .245) were similar between the two groups. Overall primary patency was 51.7% (55.5% [vein group] vs. 51.7% [HePTFE group]; p = .897) and overall secondary patency was 64.2% (74.6% [vein group] vs. 55.6% [HePTFE group]; p = .119), all without significance after 5 years. However, limb salvage (79.1%) was significantly different (90.0% [vein group] vs. 62.9% [HePTFE group]; p = .021). Survival was similar between the groups (47.3% vs. 42.9%; p = .582) as well as MALE free survival (69.4% vs. 55.0%; p = .348). Conclusion Bypasses to the below knee popliteal artery show good results in patients with CLI unsuitable for endovascular therapy. Vein is still the first line graft material.
Databáze: OpenAIRE
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