The efficacy of dextran 40 in preventing early postoperative thrombosis following difficult lower extremity bypass.
In a randomized, multicenter trial the efficacy of intravenous dextran 40 (D-40; Rheomacrodex) in preventing early postoperative thrombosis was tested in the following difficult lower extremity bypasses: (1) femoropopliteal with poor runoff using autologous vein (AV), (2) femoropopliteal using grafts other than AV, (3) single or sequential bypasses to infrapopliteal arteries, and (4) the above-mentioned bypasses with adjunctive procedures that destroy adjacent endothelial surfaces (e.g., thrombectomy and endarterectomy). Five units of D-40 was administered to the experimental group at 75 to 100 ml/hr, two during and immediately after operation and one each 3 days postoperatively. Antiplatelet drugs were withheld until 1 week after surgery. The overall 1-week occlusion rate was 6.9% (5 of 73) with D-40 and 20.5% (17 of 83) for controls, which is statistically significant. Particularly significant was the difference in group 3: 0% (0 of 28) for D-40 and 27.8% (10 of 36) for controls. In the same time period there were no occlusions in group I and only one occlusion each with AV grafts in both D-40 and control groups, 2.6% (1 of 38). When grafts other than AV were used, the occlusion rate was significantly lower at 1 week for D-40, 11.4% (4 of 35), than controls, 35.6% (16 of 45). By 1 month the protective effect of D-40 was partially lost--15.3% (11 of 72) for D-40 and 20.7% (17 of 82) for controls (no statistical significance). Use of antiplatelet drugs during this period had no discernible effect.
D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D002986:Clinical Trials as Topic; D003911:Dextrans / Q000008:administration & dosage / Q000627:therapeutic use*; D004691:Endarterectomy; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007263:Infusions, Parenteral; D007866:Leg / Q000098:blood supply*; D011150:Popliteal Artery / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D011897:Random Allocation; D013927:Thrombosis / Q000517:prevention & control* / Q000601:surgery; D014680:Veins / Q000637:transplantation*
D003911:Dextrans