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Long-term results of reconstructive surgery for femoro-popliteal arterial occlusive lesions
Insights
Autogenous vein grafts demonstrate superior long-term patency for femoro-popliteal arterial occlusive disease compared to endarterectomy. Synthetic grafts showed complete failure, highlighting the importance of distal vessel run-off.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Arterial Reconstruction
Background:
- Femoro-popliteal arterial occlusive lesions present a significant challenge in vascular reconstruction.
- Evaluating the long-term efficacy of different reconstructive techniques is crucial for patient outcomes.
Purpose of the Study:
- To compare the cumulative patency rates of various surgical procedures for femoro-popliteal arterial occlusive lesions.
- To assess the impact of distal vessel run-off on the success of these reconstructions.
Main Methods:
- Retrospective review of 156 reconstructions in 141 patients.
- Analysis of autogenous vein grafts, endarterectomies, and synthetic bypass prostheses.
- Evaluation of patency rates based on reconstructive procedure and distal run-off quality.
Main Results:
- Autogenous vein grafts achieved a 12-year cumulative patency rate of 60.7%, significantly higher than endarterectomy (27.4%).
- All 11 synthetic bypass prostheses failed within 3 years due to thrombosis.
- Good and fair distal run-off correlated with significantly superior patency rates (77.1% and 57.3%) compared to poor run-off (10.3%).
- In situ grafts (72.2%) showed slightly better patency than free grafts (65.5%).
Conclusions:
- Autogenous vein grafts are a superior option for femoro-popliteal arterial reconstruction compared to endarterectomy.
- The quality of distal run-off is a critical determinant of long-term graft patency.
- Synthetic grafts are not recommended for femoro-popliteal occlusive lesions due to high failure rates.
Abstract:
A retrospective review of 156 reconstructions performed for femoro-popliteal arterial occlusive lesions in 141 patients was carried out in terms of the reconstructive procedure and the degree of out-flow in the distal vessel. The cumulative patency rate for 95 autogenous vein grafts was 60.7 per cent at 12 years and higher than the 27.4% patency rate for 50 endarterectomies (p less than 0.001). All of 11 synthetic bypass prostheses failed with late thrombosis within 3 years after operation. The cumulative patency rate in cases with good distal run-off vessel and those with fair distal run-off vessel were 77.1% at 11 years and 57.3% at 12 years, respectively, and these values were significantly superior to 10.3% in cases with poor distal run-off vessel. The patency rate for 41 in situ grafts was 72.2%, being superior to 65.5% for 42 free grafts.