title: ePTFE grafts for femoro-crural bypass--improved results with combined adjuvant venous cuff and arteriovenous fistula?
abstract: Patency rates for long prosthetic bypass grafts with standard anastomoses to single tibial or peroneal arteries are very poor. Adjuvant techniques employed with the aim of improving patency rates include arteriovenous fistula (AVF) at the distal anastomosis to accelerate blood flow above thrombotic threshold velocity (TTV) and a venous cuff (VC) or patch which may reduce or modify anastomotic myointimal hyperplasia within the recipient artery. In a consecutive series of 43 femoro-crural bypasses with ePTFE grafts, adjuvant AVF and VC procedures have been applied in combination. The results are compared with those of an antecedent series of 76 similar grafts with AVF alone and a contemporaneous series of 179 autologous vein grafts. All operations were undertaken for critical limb ischaemia with anastomosis to a single calf or pedal artery. The three groups were well matched for age, sex, diabetes, smoking history, previous surgery and the proportion with rest pain and tissue necrosis. The cumulative patency rate at 2 years for ePTFE grafts with combined AVF and VC was 62% compared to 28% for those with AVF alone and 68% for autologous vein grafts. The patency rate for prosthetic grafts with AVF and VC was significantly higher than AVF alone (p < 0.01) and did not differ significantly from vein grafts. Cumulative limb salvage rates for ePTFE grafts with AVF and VC were 68% at 1 year and 55% at 2 years compared to 38 and 35% for AVF alone and 78 and 69% for vein grafts.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Vascular Surgery, Broadgreen Hospital, Liverpool, U.K.
authors.forename: P L
authors.initials: PL
authors.lastname: Harris
authors.forename: A
authors.initials: A
authors.lastname: Bakran
authors.forename: L
authors.initials: L
authors.lastname: Enabi
authors.forename: D M
authors.initials: DM
authors.lastname: Nott
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D015993:Life Tables; D008297:Male; D011138:Polytetrafluoroethylene; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*
chemical_list: D011138:Polytetrafluoroethylene