Femorotibial bypass grafting for lower limb ischaemia

Area of Science:

• Vascular Surgery
• Cardiovascular Research
• Biomaterials Science

Background:

• Femorotibial bypass grafting is crucial for limb salvage in peripheral arterial disease.
• Graft patency remains a challenge, particularly in complex cases.
• Various graft materials are available, each with distinct performance characteristics.

Purpose of the Study:

• To evaluate the long-term outcomes of femorotibial bypass grafts.
• To compare the patency rates of autogenous saphenous vein grafts versus synthetic alternatives.
• To identify factors influencing graft failure, including patient comorbidities and technical aspects.

Main Methods:

• Retrospective analysis of 305 femorotibial bypass grafts in 246 patients.
• Use of autogenous saphenous vein, PTFE, human umbilical cord vein, venous allograft, and knitted dacron velour grafts.
• Life-table method for cumulative patency analysis over a mean follow-up of 62.3 months.
• Analysis of factors including diabetes, indication for surgery, and angiographic run-off.

Main Results:

• Overall hospital mortality was 2.6%. Early graft failure occurred in 29.2% of cases.
• One, five, and ten-year cumulative patency for saphenous vein grafts were 73%, 53%, and 35% (claudication).
• Patency rates for arterial substitutes were significantly lower (35% at 1 year, 15% at 5 years).
• Diabetic patients exhibited significantly lower graft patency (p=0.002).
• Poor distal run-off (single visualized branch) was associated with significantly lower patency (p=0.001).

Conclusions:

• Autogenous saphenous vein grafts offer superior long-term patency compared to synthetic grafts for femorotibial bypass.
• Graft patency is significantly compromised in diabetic patients and those with limited distal arterial supply.
• Early graft failure is a major concern, necessitating careful patient selection and surgical technique optimization.