Venous Conduits Have Superior Patency Compared with Prosthetic Grafts for Femorofemoral Bypass

Abstract

The objective of the study was to compare the outcomes of externally supported polytetrafluoroethylene (PTFE) grafts and femoral vein as conduits for femorofemoral crossover grafts. This is a retrospective review of consecutive femorofemoral crossover grafts atourinstitution between January 2005 and March 2016. Patient demographics, indications,complication rates, patency rates, and survival rates were compared between femorofemoral grafts created with either PTFE or femoral vein conduits, autogenous or cryopreserved. One hundred nineteen femorofemoral crossover bypasses (89 PTFE, 30 vein [18 autogenous and 12 cryopreserved femoral veins]) were performed. Most patients underwent isolated femorofemoral bypass alone (76% isolated femorofemoral bypass versus 24% axillobifemoral bypass). A greater proportion of patients who received vein grafts were female (PTFE 37% vs. vein 60%, P=0.028) and had prior bypasses (PTFE 33% vs. vein 73%, P<0.001). PTFE bypasses were performed primarily for chronic limb ischemia (61.8%), while most venous bypasses were for infections (80%, P<0.001). Femoral vein conduits were used in cases of infected aortic or extra-anatomical grafts (N=20) or groin infection (N=5). The 30-day complication rate was 38.7% and was not different between groups (36% for PTFE, 44.4% for autologous vein grafts and 50% for cryovein, P=0.33) with wound complications being most frequent (18% PTFE, 27.8% autologous vein, 16.7% cryovein, P=0.25). Patients receiving vein grafts were more likely to receive blood transfusion (34.8% PTFE vs. 70% vein, P=0.001). Overall, median follow-up was 9.8months (range 0-107). Primary patency rates at 1, 2, and 3years were 83.7 %, 73.7% and 69.8%, respectively, for PTFE bypasses, and 100% for all time points for venous grafts, respectively (log rank, P=0.03). Primary-assisted and secondary patency rates were not significantly different between the 2 groups (log rank, P=0.16). Survival rates at 1, 2, and 3years were 82%, 76.4% and 69.7%, respectively, for patients with PTFE grafts versus 76.7%, 73.3%, and 55%, respectively, for patients with vein grafts, respectively (log rank, P=0.17). While the indications for procedure differed in this series, femoral veins in femorofemoral bypasses have overall superior primary patency and similar complication rates compared with PTFE grafts. Based on this series, femoral vein, either autologous or cryopreserved, appears to be a suitable conduit for femorofemoral bypasses, and in some cases, it may be the preferred conduit.