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The Choice of Material for Above-Knee Femoropopliteal Bypass: A 20-Year Experience

The Choice of Material for Above-Knee Femoropopliteal Bypass: A 20-Year Experience Abstract Objective: The choice of material for above-knee femoropopliteal bypass grafting is a matter of continuing controversy for various reasons. The most important argument in favor of alloplastic grafts is to preserve the autologous saphenous vein for a below-knee bypass, which might become indicated at a later date. Design: A consecutive series of above-knee reconstructions were analyzed with regard to long-term behavior. Early graft occlusions were not included, and the median follow-up was 83 months. Setting: A university hospital with a particular interest in vascular surgery. Patients and Methods: Four hundred forty-two patients received either autologous saphenous vein (n=310) or alloplastic graft (n=132) material, and were analyzed in a univariate (Kaplan-Meier) and multivariate (Cox) manner. Main Outcome Measures: Analysis as to whether alloplastic graft material provides equal or less favorable results as compared with autologous saphenous vein material, in terms of primary and secondary patency, secondary below-knee bypass grafting, limb salvage, and survival. Results: Although univariate analysis demonstrated a significantly better primary patency rate for autologous saphenous vein material, multivariate analysis did not show any effect of the material in terms of patency, limb salvage, and survival. The frequency of secondary belowknee repair was 7% (31 patients); 56% were performed in the first 2 years postoperatively. This amounted to an estimated probability of 4.4% and 12.3% at 18 years, respectively. Conclusion: The small probability of secondary below-knee repair in our series does not support the policy to use alloplastic grafts routinely for a primary above-knee bypass, to spare the saphenous vein. Therefore, patients should be offered the best material for the first operation even at the above-knee level.(Arch Surg. 1994;129:297-302) References 1. De Weese JA, Rob CG. Autogenous venous grafts ten years later . Surgery . 1977;82:775-784. 2. Brewster DC, LaSalle AJ, Robison JG, Robinson JG, Strayhorn EC, Darling RC. Factors affecting patency of femoropopliteal bypass grafts . Surg Gynecol Obstet . 1983:157:437-442. 3. Bergan JJ, Veith FJ, Bernhard VM, et al. Randomization of autogenous vein and polytetrafuoroethylene grafts in femoro-distal reconstruction . Surgery . 1982; 92:921-930. 4. Tilanus HW, Obertop H, Van Urk H. Saphenous vein or PTFE for femoropopliteal bypass . Ann Surg . 1985;202:780-782.Crossref 5. Veith FJ, Gupta SK, Ascer E, et al. Six-year prospective multicenter randomized comparsion of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstruction . J Vasc Surg . 1986;3:104-114.Crossref 6. Rosenthal D, Levine K, Stanton PE, Lamis PA. Femoropopliteal bypass: the preferred site for distal anastomosis . Surgery . 1983;93:1-4. 7. Quinones-Baldrich WJ, Martin-Paredero V, Baker JD, Busuttil RW, Machleder HI, Moore WS. Polytetrafluoroethylene grafts as the first-choice arterial substitute in femoropopliteal revascularization . Arch Surg . 1984:119:1238-1243.Crossref 8. Rosen RC, Johnson WC, Bush HL, Cho SI, O'Hara ET, Nabseth DC. Staged infrainguinal revascularization: initial prosthetic above-knee bypass followed by a distal vein bypass for recurrent ischemia . Am J Surg . 1986;152:224-230.Crossref 9. Cornfield J. Randomization by group: a formal analysis . Am J Epidemiol . 1978; 108:100-102. 10. Cochran WG. Sampling Techniques . 3rd ed. New York, NY: John Wiley & Sons Inc; 1977. 11. Fontaine R, Kim M, Kieny R. Die chirurgische Behandlung der peripheren Durchblutungsstörungen . Helv Chir Acta . 1954;21:499-533. 12. Cox DR. Regression models and life tables . JR Stat Soc . 1972;B34:187-220. 13. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;53:457-481.Crossref 14. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep . 1966;50:163-170. 15. Breslow N. A generalized Kruskal-Wallis test for comparing k-samples subject to unequal patterns of censorship . Biometrika . 1970;57:579-594.Crossref 16. Yashar JJ, Thompson R, Burnard RJ, Weyman AK, Yashar J, Hopkins RW. Dacron vs vein for femoropopliteal arterial bypass . Arch Surg . 1981;116:1037-1040.Crossref 17. Simone ST, Dubner B, Safi AR, et al. Comparative review of early and intermediate patency rates of polytetrafluoroethylene and autogenous saphenous vein grafts for lower extremity ischemia . Surgery . 1981;90:991-999. 18. Veith FJ, Gupta SK, Daly V. Management of early and late thrombosis of expanded polytetrafluoroethylene (PTFE) femoropopliteal bypass grafts: favorable prognosis with appropriate reoperation . Surgery . 1980;87:581-587. 19. Brewster DC, LaSalle AJ, Robinson JG, Strayhorn EC, Darling RC. Femoropopliteal graft failures: clinical consequences and success of secondary reconstructions . Arch Surg . 1983;118:1043-1047.Crossref 20. Criqui MH, Langer RD, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease . N Engl J Med . 1992;326:381-386.Crossref 21. Kretschmer G, Wenzl E, Schemper M, et al. Influence of postoperative anticoagulant treatment on patient survival after femoropopliteal vein bypass surgery . Lancet . 1988;1:797-799.Crossref 22. Smith P, Arnesen H, Holme J. The effect of warfarin on mortality and rein-farction after myocardial infarction . N Engl J Med . 1990;323:147-152.Crossref 23. Dormandy JA, Mahir MS. The natural history of peripheral atheromatous disease of the legs . In: Greenhalgh RM, Jamieson CW, Nicolaides AN, eds. Vascular Surgery: Issues in Current Practice . New York, NY: Grune & Stratton; 1986:3-18. 24. Szilagyi DE, Hageman JH, Smith RF, Elliott JP, Brown F, Dietz P. Autogenous vein grafting in femoropopliteal atherosclerosis: the limits of its effectiveness . Surgery . 1979;86:836-851. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Choice of Material for Above-Knee Femoropopliteal Bypass: A 20-Year Experience

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References (28)

Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1994.01420270073017
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: The choice of material for above-knee femoropopliteal bypass grafting is a matter of continuing controversy for various reasons. The most important argument in favor of alloplastic grafts is to preserve the autologous saphenous vein for a below-knee bypass, which might become indicated at a later date. Design: A consecutive series of above-knee reconstructions were analyzed with regard to long-term behavior. Early graft occlusions were not included, and the median follow-up was 83 months. Setting: A university hospital with a particular interest in vascular surgery. Patients and Methods: Four hundred forty-two patients received either autologous saphenous vein (n=310) or alloplastic graft (n=132) material, and were analyzed in a univariate (Kaplan-Meier) and multivariate (Cox) manner. Main Outcome Measures: Analysis as to whether alloplastic graft material provides equal or less favorable results as compared with autologous saphenous vein material, in terms of primary and secondary patency, secondary below-knee bypass grafting, limb salvage, and survival. Results: Although univariate analysis demonstrated a significantly better primary patency rate for autologous saphenous vein material, multivariate analysis did not show any effect of the material in terms of patency, limb salvage, and survival. The frequency of secondary belowknee repair was 7% (31 patients); 56% were performed in the first 2 years postoperatively. This amounted to an estimated probability of 4.4% and 12.3% at 18 years, respectively. Conclusion: The small probability of secondary below-knee repair in our series does not support the policy to use alloplastic grafts routinely for a primary above-knee bypass, to spare the saphenous vein. Therefore, patients should be offered the best material for the first operation even at the above-knee level.(Arch Surg. 1994;129:297-302) References 1. De Weese JA, Rob CG. Autogenous venous grafts ten years later . Surgery . 1977;82:775-784. 2. Brewster DC, LaSalle AJ, Robison JG, Robinson JG, Strayhorn EC, Darling RC. Factors affecting patency of femoropopliteal bypass grafts . Surg Gynecol Obstet . 1983:157:437-442. 3. Bergan JJ, Veith FJ, Bernhard VM, et al. Randomization of autogenous vein and polytetrafuoroethylene grafts in femoro-distal reconstruction . Surgery . 1982; 92:921-930. 4. Tilanus HW, Obertop H, Van Urk H. Saphenous vein or PTFE for femoropopliteal bypass . Ann Surg . 1985;202:780-782.Crossref 5. Veith FJ, Gupta SK, Ascer E, et al. Six-year prospective multicenter randomized comparsion of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstruction . J Vasc Surg . 1986;3:104-114.Crossref 6. Rosenthal D, Levine K, Stanton PE, Lamis PA. Femoropopliteal bypass: the preferred site for distal anastomosis . Surgery . 1983;93:1-4. 7. Quinones-Baldrich WJ, Martin-Paredero V, Baker JD, Busuttil RW, Machleder HI, Moore WS. Polytetrafluoroethylene grafts as the first-choice arterial substitute in femoropopliteal revascularization . Arch Surg . 1984:119:1238-1243.Crossref 8. Rosen RC, Johnson WC, Bush HL, Cho SI, O'Hara ET, Nabseth DC. Staged infrainguinal revascularization: initial prosthetic above-knee bypass followed by a distal vein bypass for recurrent ischemia . Am J Surg . 1986;152:224-230.Crossref 9. Cornfield J. Randomization by group: a formal analysis . Am J Epidemiol . 1978; 108:100-102. 10. Cochran WG. Sampling Techniques . 3rd ed. New York, NY: John Wiley & Sons Inc; 1977. 11. Fontaine R, Kim M, Kieny R. Die chirurgische Behandlung der peripheren Durchblutungsstörungen . Helv Chir Acta . 1954;21:499-533. 12. Cox DR. Regression models and life tables . JR Stat Soc . 1972;B34:187-220. 13. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;53:457-481.Crossref 14. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep . 1966;50:163-170. 15. Breslow N. A generalized Kruskal-Wallis test for comparing k-samples subject to unequal patterns of censorship . Biometrika . 1970;57:579-594.Crossref 16. Yashar JJ, Thompson R, Burnard RJ, Weyman AK, Yashar J, Hopkins RW. Dacron vs vein for femoropopliteal arterial bypass . Arch Surg . 1981;116:1037-1040.Crossref 17. Simone ST, Dubner B, Safi AR, et al. Comparative review of early and intermediate patency rates of polytetrafluoroethylene and autogenous saphenous vein grafts for lower extremity ischemia . Surgery . 1981;90:991-999. 18. Veith FJ, Gupta SK, Daly V. Management of early and late thrombosis of expanded polytetrafluoroethylene (PTFE) femoropopliteal bypass grafts: favorable prognosis with appropriate reoperation . Surgery . 1980;87:581-587. 19. Brewster DC, LaSalle AJ, Robinson JG, Strayhorn EC, Darling RC. Femoropopliteal graft failures: clinical consequences and success of secondary reconstructions . Arch Surg . 1983;118:1043-1047.Crossref 20. Criqui MH, Langer RD, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease . N Engl J Med . 1992;326:381-386.Crossref 21. Kretschmer G, Wenzl E, Schemper M, et al. Influence of postoperative anticoagulant treatment on patient survival after femoropopliteal vein bypass surgery . Lancet . 1988;1:797-799.Crossref 22. Smith P, Arnesen H, Holme J. The effect of warfarin on mortality and rein-farction after myocardial infarction . N Engl J Med . 1990;323:147-152.Crossref 23. Dormandy JA, Mahir MS. The natural history of peripheral atheromatous disease of the legs . In: Greenhalgh RM, Jamieson CW, Nicolaides AN, eds. Vascular Surgery: Issues in Current Practice . New York, NY: Grune & Stratton; 1986:3-18. 24. Szilagyi DE, Hageman JH, Smith RF, Elliott JP, Brown F, Dietz P. Autogenous vein grafting in femoropopliteal atherosclerosis: the limits of its effectiveness . Surgery . 1979;86:836-851.

Journal

Archives of SurgeryAmerican Medical Association

Published: Mar 1, 1994

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