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Angiographic assessment of biografts for femoropopliteal bypass
Insights
Biograft femoropopliteal bypasses show a 6-year patency rate of 64%. Angiography revealed graft changes over time, including dilatation and stenosis, with clinical implications discussed.
Area of Science:
- Vascular Surgery
- Biomaterials Science
- Medical Imaging
Background:
- Femoropopliteal bypass grafting is a common procedure for peripheral artery disease.
- Biograft materials offer potential alternatives to autologous vein or synthetic grafts.
- Long-term patency and morphological changes of Biografts require thorough investigation.
Purpose of the Study:
- To analyze the long-term patency rates of femoropopliteal bypasses using Biografts.
- To assess the morphological changes of Biografts through follow-up angiography.
- To discuss the clinical implications of observed graft alterations.
Main Methods:
- Retrospective analysis of 257 femoropopliteal bypass procedures utilizing Biografts.
- Calculation of cumulative patency rates at 6 years.
- Follow-up angiography performed at 1 year and 3-5 years post-procedure to evaluate graft morphology.
Main Results:
- Overall 6-year cumulative patency rate was 64% (74% for above-knee, 44% for below-knee).
- Early angiography (1 year) showed minimal alterations (e.g., tortuosity, stenosis <4%).
- Later angiography (3-5 years) revealed significant changes: tortuosity (6%), segmentation (29%), anastomotic aneurysms (2%), and diameter changes (46%) including dilatation and stenosis.
Conclusions:
- Biograft femoropopliteal bypasses demonstrate moderate long-term patency.
- Progressive morphological changes, particularly graft dilatation and stenosis, occur over time.
- These findings necessitate careful clinical monitoring and may influence future graft selection and management strategies.
Abstract:
A series of 257 femoropopliteal bypass procedures with a Biograft is analysed. The cumulative patency rate after 6 years is 64% for the whole series. This corresponds with a cumulative patency rate of 74% for AK cases and 44% for BK cases. Follow-up angiography to assess the morphology of the Biografts, was performed after 1 year and after 3-5 years. Angiography after 1 year (N = 126) showed few alterations: tortuosity in 3%, segmentation or wrinkling in 3%, slight diffuse dilatation in 4% and local stenosis in 2%. Angiography after 3-5 years (N = 82) revealed interesting changes. Besides tortuosity in 6% and segmentation in 29%, there were anastomotic aneurysms in 2%. Changes in the diameter of the body of the graft were remarkable and occurred in 46%. Diffuse regular or irregular dilatation, local ectasia or stenosis was found. Clinical implications are discussed.