Early results of infrainguinal arterial reconstruction with a modified biological conduit.
We implanted 112 glutaraldehyde-fixed bovine carotid artery grafts (BioPolyMeric [BPM]) for infrainguinal reconstruction in 107 legs of 98 patients. Indications for surgery were disabling claudication in 28%, rest pain in 33% and tissue loss in 39%. In 32%, BPM bypass followed failed ipsilateral reconstruction. Autologous vein was either absent or inadequate in 60% of cases. BPM was used preferentially over vein in above-knee bypasses. The distal anastomosis was to the above-knee popliteal artery in 40%, to the below-knee popliteal artery in 35%, and to the tibial arteries in 25%. Follow-up was available from one to 25 months, with a mean of nine months. Wound complications developed after 9% of operations, including seven (6%) graft infections. Both patent grafts that became infected were salvaged. Four patients (4%) died within 60 days of surgery due to cardiac complications. Life-table primary and secondary patencies of all grafts were 64% and 65% at one year, and 48% and 62% at two years, respectively. The only factor significantly affecting graft patency was the location of the distal anastomosis (p < .01). Primary patencies at one and two years to the above-knee popliteal artery were 90% and 80%, to the below-knee popliteal artery were 56% and 37%, and to the infrapopliteal arteries were 34% and 26%. Bypass to 16% of extremities resulted in amputation, including 5% that were amputated with patent grafts. No limb loss occurred as a result of operation for claudication. In conclusion, BPM grafts provide early results comparable to saphenous vein above the knee.(ABSTRACT TRUNCATED AT 250 WORDS)
Wagner
W H
WH
Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Levin
P M
PM
Treiman
R L
RL
Cossman
D V
DV
Foran
R F
RF
Cohen
J L
JL
D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D016909:Tibial Arteries / Q000601:surgery*; D014654:Vascular Patency