Bovine Pericardial Patch – A Good Alternative in Femoral Angioplasty

Abstract

Introduction - This study investigates the results of bovine pericardial patch closure in femoral endarterectomies. The main focuses are immediate as well as later complications such as infections, stenosis at the patch site and patch ruptures. Methods - This retrospective study consists of all the femoral endarterectomies with bovine pericardial patch closure (Peri-Guard Supple® or Xenosure®) performed in Helsinki University Hospital (HUH) from January 1 2010 to July 31 2017. Patient data was collected retrospectively from the prospectively maintained Husvasc-registry and from the prosthesis registry in the operating room. Primary endpoints are restenosis at the patch site, patch ruptures and patch infections. Secondary endpoints are restenosis and infections at the entire surgical site. Results - During the study period 1160 femoral endartectomies including angioplasty took place in HUH. In 167 (14.4%) bovine pericardial patch closure was used. The indications for operations were claudication (28%), ischemic wound (22.6%) and rest pain (21.4%). Of the operations 51.8% were hybrid procedures including endovascular treatment either proximally (51.7%), distally (32.2%) or in both directions (16.1%). Median follow up time was 2.6 years, during which five (2.4.%) restenosis at the patch site were detected, four with ischemic symptoms and one found incidentally. If proximal and distal restenoses are included there were altogether 11 (6.5%) restenosis. Infections at the whole surgical site appeared in 23 (13.7%) patients, majority (n=20) detected within 30 days. Deep infections affecting also the patch occurred in 11 (6.5%) patients. There were no patch ruptures during the follow up. Eight (4.8%) patients had the patch removed due to infection (n=2), stenosis (n=5) and reoperation technique (n=1). Conclusion - Bovine pericardial patch provides a safe choice in femoral angioplasty with reasonably good patency results and relatively small risk for complications and can be considered comparable to autologous vein patch.