Experience with heparin-bonded collagen-coated grafts for infrainguinal bypass

The perfect conduit for infrainguinal reconstructive surgery does not exist. When autologous vein is not available, then a prosthetic graft must be used. The use of a heparin-bonded graft has the theoretical advantage of reducing smooth muscle cell proliferation and thrombus formation, thereby reducing occlusion rates. The application of a collagen layer to the external surface of the graft serves to reduce transfabric haemorrhage. Forty-six patients underwent 47 infrainguinal reconstructions using heparin-bonded collagen-coated Dacron grafts over a 4-year period. Twenty grafts were for disabling claudication and 27 for critical ischaemia. Twenty-two grafts were to the above knee popliteal artery (47%), 10 to the below knee popliteal (21%) and 15 to one of the crural vessels (32%). There was a cumulative patency at 4 years of 69% for the above knee grafts, and 30-month patency of 58% and 45% for the below knee and crural grafts, respectively. There were three deaths over the study period and eight patients required major amputations.