5-year Cumulative Patency Rates Research Articles

Autogenous composite vein bypass graft for infrainguinal arterial reconstruction

Purpose: Lower extremity arterial reconstruction in the absence of adequate greater saphenous vein remains a challenging problem in contemporary vascular practice. The purpose of this review is to evaluate the long-term results of autogenous composite vein grafts used for infrainguinal arterial bypass grafting. Methods: We retrospectively evaluated a prospective vascular registry and reviewed inpatient and office records. Results: From June 1983 to September 1999, 165 autogenous composite vein infrainguinal bypass grafts were performed in 154 patients (87 men, 67 women; mean age, 69 years). The mean follow-up was 25 months (range, 3-147). Patients had the usual risk factors, including a 30% incidence of prior coronary bypass grafting. Forty-eight percent of bypass grafts were performed after failed previous reconstructions, and 90% were performed for limb salvage. The conduits were comprised of 2 segments (75%), 3 segments (23%), and 4 segments (2%). The distal anastomosis was at the popliteal level in 17% and the tibial/pedal level in 83%. The 30-day operative mortality rate was 1.8%. Perioperative graft failure (< 30 days) occurred in 18 bypass grafts (11%), resulting in early amputation (< 30 days) in 1.2%. The overall 5-year cumulative patency rates were 44% ± 5% for primary patency, 63% ± 5% for primary-assisted patency (PAP), and 65% ± 5% for secondary patency (SP). A high revision rate for stenosis or thrombosis was required during follow-up to maintain patency of the grafts (27%). Limb salvage was 81% ± 5% at 5 years. Primary reconstructions with composite vein fared significantly better than secondary reconstructions (SP 76% vs 54% at 5 years, P <.01). Arm vein composites showed superior patency compared with greater saphenous vein composites (SP 79% vs 61% at 5 years, P <.05). Conclusions: Infrainguinal reconstruction with autogenous composite vein results in durable graft patency and limb salvage rates in patients with few alternatives for revascularization. Intensive graft surveillance with aggressive graft revision is necessary to achieve these results. (J Vasc Surg 2001;33:259-65.)

Reconstruction for renal artery aneurysm and its effect on hypertension.

many renal artery aneurysms (RAA) are diagnosed incidentally in the course of investigations for hypertension and their management is controversial. to review the results of renal artery reconstruction for RAA. between January 1978 and December 1998 111 RAR were performed in 81 kidneys in 71 patients. fifty-nine patients were hypertensive, three had a creatinine >2.0 mg/dl and one was on dialysis. The principal underlying pathology was fibromuscular dysplasia (39) and atherosclerosis (17). The mean RAA diameter was 2.2 (range 1-15) cm overall and 3.5 (range 2-10) cm in four patients who presented with rupture. Fifty-one patients had renal artery stenosis. Autogenous material was used in 105 RAR. There was no 30-day mortality and the morbidity rate was 16%. The 5-year cumulative patency rate was 69%. Hypertension was cured in 25% and improved in 39%. RAR tested for RAA treats hypertension and reduces the risk of rupture and distal embolisation.

経皮的レーザー血管形成術 (PTLA) の現況

One hundred and thirty four lesions of peripheral arterial occlusive diseases were treated with PTLA, using 1064nm continuous wave Nd: YAG laser during the period of March, 1985 through March, 1993. In most cases a ceramic tip was used for contact lasing method. A bare laser fiber was also used in a small number of lesions. The initial success rate of PTLA is 87.3%. The cumulative patency rate dropped to 67.7% at 8 years from 89.7% at 6 years. The main cause of decreased patency rate seems to be due to inclusion of more difficult cases to treat. Our 5-year cumulative patency rate of all lesions treated by PTLA revealed 10 to 15% improvement, when compared with that of conventional PTA. Our 6-year comulative patency rate revealed a better patency rate among lesions less than 10cm in length than that of lesions longer than 10cm. PTLA has been especially useful in lesions in which a guidewire could not be passed, and also in hard lesions. Laser ablation of atheromatous plaque seemed to prevent recoiling of stenotic arterial wall and to create better compresibility. PTLA seems to be a useful adjunct to improve initial success rate and the long term patency rate of PTA.

Is surveillance to detect failing polytetrafluoroethylene bypasses worthwhile?: Twelve-year experience with ninety-one grafts.

The purpose of this study was to review the 91 failing polytetrafluoroethylene (PTFE) grafts that were treated at our institution over the past 12 years to better understand their cause and improve the diagnosis and treatment of these grafts. Eighty-five patients with 91 failing grafts were retrospectively reviewed. The 144 graft-threatening lesions associated with these grafts were characterized by location (inflow artery, outflow artery, anastomosis, or graft body) and treatment method used (surgery, balloon angioplasty, or thrombolysis). Progression of atherosclerotic disease was the predominant cause of failing PTFE grafts with 43 inflow lesions and 83 outflow lesions, accounting for 87% of all lesions identified. Ten lesions (7%) were noted within the prosthetic grafts, whereas only eight (6%) lesions were noted at the anastomoses. Forty stenotic lesions 2 cm in length or less were treated with percutaneous transluminal balloon angioplasty, whereas 100 lesions were treated by patch angioplasty or graft extensions. The remaining four lesions, present within the prosthetic grafts, were treated with thrombolytic therapy. The 5-year cumulative patency rate for all failing PTFE grafts was 71%, whereas that of failing femoropopliteal PTFE grafts was 64%. The 5-year limb salvage rate for all failing PTFE grafts was 73%. The progression of inflow and outflow disease is the predominant cause of failing PTFE grafts, which suggests that this process is a more important cause of PTFE graft thrombosis than is generally recognized. Frequent PTFE graft surveillance may permit detection of some threatening lesions before graft thrombosis occurs and may help maintain and prolong graft patency. The enhanced 5-year patency and limb salvage rates for treated failing PTFE grafts compared with the known poor outcome after reinterventions for PTFE graft failure support the conclusion that surveillance of PTFE grafts is worthwhile.

Is surveillance to detect failing polytetrafluoroethylene bypasses worthwhile?: Twelve-year experience with ninety-one grafts

Purpose: The purpose of this study was to review the 91 failing polytetrafluoroethylene (PTFE) grafts that were treated at our institution over the past 12 years to better understand their cause and improve the diagnosis and treatment of these grafts.Methods: Eighty-five patients with 91 failing grafts were retrospectively reviewed. The 144 graft-threatening lesions associated with these grafts were characterized by location (inflow artery, outflow artery, anastomosis, or graft body) and treatment method used (surgery, balloon angioplasty, or thrombolysis).Results: Progression of atherosclerotic disease was the predominant cause of failing PTFE grafts with 43 inflow lesions and 83 outflow lesions, accounting for 87% of all lesions identified. Ten lesions (7%) were noted within the prosthetic grafts, whereas only eight (6%) lesions were noted at the anastomoses. Forty stenotic lesions 2 cm in length or less were treated with percutaneous transluminal balloon angioplasty, whereas 100 lesions were treated by patch angioplasty or graft extensions. The remaining four lesions, present within the prosthetic grafts, were treated with thrombolytic therapy. The 5-year cumulative patency rate for all failing PTFE grafts was 71%, whereas that of failing femoropopliteal PTFE grafts was 64%. The 5-year limb salvage rate for all failing PTFE grafts was 73%.Conclusions: The progression of inflow and outflow disease is the predominant cause of failing PTFE grafts, which suggests that this process is a more important cause of PTFE graft thrombosis than is generally recognized. Frequent PTFE graft surveillance may permit detection of some threatening lesions before graft thrombosis occurs and may help maintain and prolong graft patency. The enhanced 5-year patency and limb salvage rates for treated failing PTFE grafts compared with the known poor outcome after reinterventions for PTFE graft failure support the conclusion that surveillance of PTFE grafts is worthwhile.

Limitations of balloon angioplasty for vein graft stenosis

Vein graft stenosis remains an important contributing factor to the failure of infrainguinal arterial reconstruction. Repair of these lesions before graft occlusion provides sustained patency, yet the optimal method of repair has not been established. Percutaneous transluminal balloon angioplasty of these vein graft lesions has been repeatedly advocated as an alternative to surgical revision. Balloon angioplasty was used in 30 patients with 54 stenotic lesions occurring in autogenous vein grafts after infrainguinal reconstruction. The primary 5-year cumulative patency rate was 18% overall, with no significant differences observed among patency rates based on initial indication, length of stenotic lesion, or requirement for preliminary thrombolytic therapy. The 3-year patency rate associated with vein graft lesions requiring only a single angioplasty proved significantly higher (59%) than those requiring repetitive dilations (6%). It is our conclusion that balloon angioplasty for vein graft stenosis has significant limitations in providing sustained secondary patency.

What is the proper role of polytetrafluoroethylene grafts in infrainguinal reconstruction?

Polytetrafluoroethylene grafts have been used extensively for infrainguinal vascular reconstruction either as the conduit of choice or as a substitute when saphenous vein is unavailable. Although numerous studies have shown satisfactory early patency rates, the long-term efficacy of these grafts in a large number of patients for specific indications and in various positions has been less well defined. From 1977 to 1987 we used four PTFE grafts from three different manufacturers to perform 300 infrainguinal reconstructions on 240 patients on our vascular service. The indications for surgery were disabling claudication in 28% and limb salvage in 72%. The 30-day operative mortality of 1% was not different from the 1.4% associated with infrainguinal autogenous vein grafting. The 5-year cumulative patency rate achieved with all infrainguinal polytetrafluoroethylene grafts was 35%, significantly higher for grafts placed for claudication (57%) than those placed for limb salvage (24%). There were no significant differences between the above-knee and below-knee locations for distal anastomoses regardless of indication, but femoropopliteal grafts provided significantly higher 5-year patency (37%) than infrapopliteal grafts (12%). Comparison of the 5-year patency rates among the three manufacturers of polytetrafluoroethylene grafts showed no significant differences. Fifty-four polytetrafluoroethylene grafts that failed underwent 67 revisions after catheter thrombectomy or thrombolysis, which resulted in a minimal 11% 5-year patency rate. Based on this experience, it is concluded that infrainguinal polytetrafluoroethylene prostheses provide significantly inferior results when compared with autogenous reconstruction.

What is the proper role of polytetrafluoroethylene grafts in infrainguinal reconstruction?

Polytetrafluoroethylene grafts have been used extensively for infrainguinal vascular reconstruction either as the conduit of choice or as a substitute when saphenous vein is unavailable. Although numerous studies have shown satisfactory early patency rates, the long-term efficacy of these grafts in a large number of patients for specific indications and in various positions has been less well defined. From 1977 to 1987 we used four PTFE grafts from three different manufacturers to perform 300 infrainguinal reconstructions on 240 patients on our vascular service. The indications for surgery were disabling claudication in 28% and limb salvage in 72%. The 30-day operative mortality of 1% was not different from the 1.4% associated with infrainguinal autogenous vein grafting. The 5-year cumulative patency rate achieved with all infrainguinal polytetrafluoroethylene grafts was 35%, significantly higher for grafts placed for claudication (57%) than those placed for limb salvage (24%). There were no significant differences between the above-knee and below-knee locations for distal anastomoses regardless of indication, but femoropopliteal grafts provided significantly higher 5-year patency (37%) than infrapopliteal grafts (12%). Comparison of the 5-year patency rates among the three manufacturers of polytetrafluoroethylene grafts showed no significant differences. Fifty-four polytetrafluoroethylene grafts that failed underwent 67 revisions after catheter thrombectomy or thrombolysis, which resulted in a minimal 11% 5-year patency rate. Based on this experience, it is concluded that infrainguinal polytetrafluoroethylene prostheses provide significantly inferior results when compared with autogenous reconstruction.

Factors affecting the outcome of 463 femorotibial reconstructions.

Between 1973 and 1986, 463 infrapopliteal bypasses were performed on 408 limbs in 383 patients at Royal Prince Alfred Hospital. There were 265 males and 118 females. Their mean age was 69 years, 30% were diabetic, 71% smoked and 38% were hypertensive. The indication for surgery was threatened limb loss in 350 limbs and short distance claudication in 58 limbs. The peri-operative mortality rate was 5%. Cumulative graft patency was 58% (s.e.m. = 2.7) at 5 years. The limb salvage rate was 66% (s.e.m. = 2.5) at 5 years. Cumulative patency rate for autogenous grafts (n = 332) was 63% (s.e.m. = 3.2) at 5 years compared with the cumulative patency rate for synthetic grafts (n = 131) of only 38% (s.e.m. = 5) at 5 years (P less than 0.05). There was no significant difference between the cumulative patency of autogenous grafts originating from the common femoral artery (n = 195) and those from the superficial femoral artery (n = 111). Cumulative patency of autogenous grafts did not significantly differ with the site of distal anastomosis; posterior tibial (n = 79), anterior tibial (n = 98), peroneal artery (n = 138) with 5-year cumulative patency rates of 65% (s.e.m. = 6.4), 65% (s.e.m. = 6.1) and 70% (s.e.m. = 4.6) respectively (P greater than 0.05). Autogenous graft material is the most important determinant of a durable result from femorotibial bypass. Proximal and distal anastomotic sites should be chosen to allow maximal utilization of available autogenous vein.