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

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.

Keywords: Comparative study; Peripheral arterial occlusive disease; Vascular graft occlusion.

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].