Abstract
There is still debate whether sintethic graft (polytetrafluoroethylene or Dacron) is equivalent to vein as bypass graft material for the above-knee femoropopliteal bypass. Therefore, we performed prospective randomized trial to compare vein with polytetrafluoroethylene/dacron for femoropopliteal bypasses with the distal anastomosis above the knee. Between January 2000 and June 2003, 121 femoropopliteal bypasses were performed. The indications for operation were severe claudication in 96 cases, rest pain in 16 cases, and ulceration in 9 cases. After randomization, 60 reversed saphenous venous bypasses and 61 polytetrafluoroethylene/dacron bypasses were performed. No perioperative mortality was seen, and 5% of the patients had minor infections of the wound, not resulting in loss of the bypass, the limb, or life. After 5 years, 37% of the patients had died and 7% were lost to follow-up. Only once saphenous vein was necessary for coronary artery bypass grafting. Primary patency rates after 5 years were 76,6% for venous bypass grafts and 59,1% for polytetrafluoroethylene/dacron grafts (p=0,035). Secondary patency rates were 83,3% for vein and 69,2% for polytetrafluoroethylene/dacron bypasses (p = 0,036). In the venous group, 10 bypasses failed, leading to four new bypasses. In the polytetrafluoroethylene group, 22 bypasses failed, leading to 12 reinterventions. After 5 years of follow-up, we conclude that a bypass with saphenous vein has better patency rates at all intervals and needs fewer reoperations. Saphenous vein should be the graft material of choice for above-knee femoropopliteal bypasses and should not be preserved for reinterventions. Polytetrafluoroethylene/dacron is an acceptable alternative if the saphenous vein is not available.
Highlights
It is generally accepted that autologous saphenous vein is the conduit of choice for a femoropoplitial bypass below the knee (, )
For the femoropopliteal bypass with the distal anastomosis above the knee, controversy still exists whether prosthetic materials like polytetrafluoroethylene, Dacron, and human umbilical vein are equivalent to autologous saphenous vein
In, this randomized controlled trial was started in our institution to answer the following questions: ) Are there any difference in cumulative patency rates between saphenous vein and polytetrafluoroethylene/Dacron bypass grafts? ) What are the consequences of bypass failure? And ) If polytetrafluoroethylene/Dacron is used, is the autologous vein still available and useful for more distal procedures or for coronary artery bypass grafting?
Summary
It is generally accepted that autologous saphenous vein is the conduit of choice for a femoropoplitial bypass below the knee ( , , , , ). In , this randomized controlled trial was started in our institution to answer the following questions: ) Are there any difference in cumulative patency rates between saphenous vein and polytetrafluoroethylene/Dacron bypass grafts? ) If polytetrafluoroethylene/Dacron is used, is the autologous vein still available and useful for more distal procedures or for coronary artery bypass grafting?. The conclusions, reported after years of follow-up, were that there was no statistical significant difference in primary and secondary patency rates between vein and polytetrafluoroethylene/Dacron. This study reports the results of our prospective randomized trial with a -year follow-up period
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