Ten Years of Experience with Aortoiliac Polytetrafluoroethylene Grafts—Effects of Postoperative Anticoagulation on Graft Function and Patient Survival

Abstract

Between 1980 and 1990, 354 aortoiliac repair procedures were performed with polytetrafluorethylene (PTFE), which had become available in 1980. This retrospective analysis was designed to show whether anticoagulation or antiaggregant treatment had beneficial effects on patient survival and graft function. In patients with unilateral aortoiliac grafts, antithrombotic therapy with phenprocoumone or acetylsalicylic acid (ASA) improved graft function (Breslow, p=0.038; Mantel, p=0.013) and long-term survival (Breslow, p=0.013; Mantel, p = 0.009). However, the results concerning survival are devaluated, because the members of the control group were older (65.9 years vs 61.1 years, Chi square test p=0.01). In patients with PTFE bifurcation grafts, in whom risk factors and age were well balanced, survival was also significantly prolonged by postoperative drug treatment in the early years of the follow-up (Breslow, p=0.038; Mantel, p=0.298), but graft function was unaffected. These results suggest that postoperative anticoagulant therapy with ASA or phenprocoumone may be of some benefit in patients undergoing iliac PTFE grafting procedures. Based on these retrospective data, a randomized prospective trial was initiated to study the effects of different drugs suppressing coagulation, ie, anticoagulants and antiaggregants, on allogenous grafts.