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Insights
Gore-tex vein composite grafts show a 63% patency rate at six years for femoral-popliteal artery bypass. This synthetic option is durable, especially for limb salvage and claudication when autogenous vein is unavailable.
Area of Science:
- Vascular Surgery
- Biomaterials in Medicine
Background:
- Autogenous saphenous vein is the preferred conduit for femoropopliteal bypass.
- Limited availability of autogenous vein necessitates alternative grafting materials.
Purpose of the Study:
- To evaluate the long-term durability and effectiveness of Gore-tex vein composite grafts for femoropopliteal bypass.
- To assess graft patency rates in patients undergoing bypass for limb salvage versus incapacitating claudication.
Main Methods:
- Retrospective analysis of 15 Gore-tex vein composite femoral-popliteal bypass procedures performed between December 1975 and December 1979.
- Preoperative arteriographic evaluation of outflow tracts.
- Life-table method used for calculating cumulative primary patency (CPR) rates.
Main Results:
- The cumulative primary patency (CPR) rate was 63% at six years.
- Early failures (3 occlusions within 2 months) occurred in patients with poor outflow.
- Late occlusions (1 at 16 months, 1 at 24 months) were managed with further intervention, salvaging the limb or graft.
- Grafts to isolated popliteal segments had poor patency, while those for claudication or with good runoff remained patent.
- Revision for distal popliteal artery stenosis at 7 months successfully salvaged one graft.
Conclusions:
- Gore-tex vein composite grafts demonstrate a durable option for femoral-popliteal bypass, achieving a 63% CPR at six years.
- Graft success is significantly influenced by the quality of the outflow tract, with poor runoff leading to early failure.
- These synthetic grafts are a viable alternative when autogenous saphenous vein is insufficient.
Abstract:
Fifteen Gore-tex vein composite femoral-popliteal artery bypass procedures were performed during the four year period of December 1975 to December 1979. Nine were performed for salvage of the limb and six, for incapacitating claudication. Preoperatively, all patients had an arteriographic evaluation of the outflow tract. CPR by the life-table method was 63 per cent at six years. Early failures were three occlusions within two months in patients with poor outflow. One late occlusion occurred at 16 months, and the limb was salvaged with a femoral tibial bypass graft. Another late occlusion was treated by thrombectomy at 24 months with continued patency. Late revision was carried out in one patient at seven months. This consisted of repair of a stenosis of the distal popliteal artery with salvage of the graft. Only two of ten grafts available for evaluation beyond one year have become occluded. All patients operated upon for claudication or with good runoff have patent grafts. On the contrary, none of the grafts to an isolated popliteal segment remained patent. When there is not sufficient autogenous saphenous vein available for femoral-popliteal bypass, the ready availability of a synthetic graft makes it an attractive choice. Nevertheless, our 63 per cent CPR at six years strongly suggests that the composite graft is a durable option.
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