Dacron femoral-popliteal bypass grafts in good-risk claudicant patients.
OBJECTIVE
To evaluate prosthetic femoral-popliteal (FP) grafts as bypass conduits in favorable patients with refractory calf claudication.


METHODS
University-affiliated urban teaching hospital.


METHODS
Cohort study of patency of 6-mm Dacron FP grafts used to treat patients with medically refractory calf claudication meeting the following criteria: nonsmoker; above-knee popliteal artery as an appropriate target vessel; > or =2-vessel tibial outflow; and postoperative anticoagulation and antiplatelet therapy. End points included primary and secondary FP graft patency, need for and outcome of subsequent intervention, limb amputation, and survival.


RESULTS
From January 1998 through March 2001, 92 patients underwent 100 Dacron bypass grafts for medically refractory claudication. All underwent serial postoperative graft surveillance using duplex ultrasound. Using the Society for Vascular Surgery/International Society of Cardiovascular Surgery criteria life-table, primary patency was 84%, assisted primary patency was 88%, and secondary patency was 90% at 5 years. Two patients (2%) died during a mean follow-up period of 49 months (range 30 to 68). No limbs required amputation. Among 9 limbs in which Dacron FP bypass failed, 8 underwent subsequent successful autogenous bypass to the popliteal artery.


CONCLUSIONS
In highly selected subjects with favorable features known to increase the likelihood of prosthetic graft patency, prosthetic FP grafts function well. Such patients undergo a simpler, more straightforward procedure than when autogenous FP bypass is performed. Subsequent success of autogenous FP repeat bypass suggests that previous prosthetic FP bypass does not threaten lower-extremity arterial outflow.
Johansen
Kaj H
KH
Vascular Institute of the Northwest, 1600 E. Jefferson St., Suite 101, Seattle, WA 98122, USA. kaj.johansen@swedish.org
Watson
James C
JC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000592:standards*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D019544:Equipment Failure Analysis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011093:Polyethylene Terephthalates / Q000009:adverse effects / Q000592:standards*; D011150:Popliteal Artery / Q000601:surgery*; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016019:Survival Analysis; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
D011093:Polyethylene Terephthalates