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[Femoropopliteal vascular replacement: vein, ePTFE or ovine collagen?]
1Klinische Abteilung für Gefsschirurgie, Universitätsklinik für Chirurgie Graz.
Insights
Autologous vein bypasses significantly outperform synthetic grafts like PTFE and ovine collagen for femoropopliteal and femorocrural reconstructions. Vein grafts are recommended over synthetic options for above-knee bypasses.
Area of Science:
- Vascular Surgery
- Biomaterials Science
Background:
- Femoropopliteal and femorocrural bypasses are crucial for limb salvage.
- The efficacy of various graft materials, including autologous veins and synthetic prostheses, remains a subject of investigation.
Purpose of the Study:
- To compare the long-term patency rates of autologous vein grafts versus synthetic grafts (PTFE, ovine collagen) in femoropopliteal and femorocrural reconstructions.
- To evaluate the suitability of alloplastic grafts as a primary choice for above-knee bypasses.
Main Methods:
- Analysis of 653 femoropopliteal and femorocrural bypasses performed between 1988 and 1995.
- Categorization of bypasses into above-knee, below-knee, and femorocrural reconstructions.
- Comparative assessment of cumulative patency rates at three years for different graft types (vein, PTFE, ovine collagen).
Main Results:
- Above-knee vein bypasses showed a 90% patency rate at 3 years, compared to 52% for PTFE and 56% for ovine collagen.
- Below-knee autologous vein bypasses had a 76% function rate, significantly higher than PTFE (30%) and ovine collagen (50%).
- Femorocrural reconstructions with saphenous vein achieved 72% patency, outperforming PTFE (<30% at 1 year) and ovine grafts (<40%).
Conclusions:
- Autologous vein grafts demonstrate superior and statistically significant patency rates compared to PTFE and ovine collagen grafts in both femoropopliteal and femorocrural positions.
- The study does not support the recommendation of using alloplastic grafts as the primary choice for above-knee bypasses to preserve saphenous veins.
- Low rates of graft infection, aneurysm formation, and mortality were observed across all groups.
Abstract:
In an eight year-period from 1988 to 1995 653 femoropopliteal and femorocrural bypasses were performed. 347 above-knee reconstructions 206 below-knee reconstructions and at last 100 femorocrural bypasses were analysed. The cumulative patency rate after a follow up of three years for above-knee vein bypasses was 90%, patency rate for PTFE grafts in the same period was 52%, for ovine collagen grafts 56%. For below-knee bypasses with autologous saphenous vein a function rate of 76% could be observed in the same period, the rate of PTFE grafts in this position was only 30%. In this position 3-year patency rates of 50% were achieved with ovine collagen grafts. This difference was statistically significant. Three years cumulative patency rate for femorocrural reconstructions with greater saphenous vein was 72%, the function rate for PTFE in this position was below 30% after a follow up of one year, with ovine grafts below 40%. Graft infection, aneurysm formation and postoperative mortality were low in all groups. Our data demonstrate, that patency rates of autologous vein bypasses could not be achieved with PTFE or ovine collagen prosthesis in any femoropopliteal the femorocrural position. We therefore cannot confirm the recommendation to use alloplastic grafts as primary choice for above knee bypasses to spare the saphenous vein.