title: Aortofemoral bypass in young patients with premature atherosclerosis: is superficial femoral vein superior to Dacron?
abstract: OBJECTIVE
  Previous studies have documented poor patency rates in "young" patients (age 55 years or younger) with premature atherosclerosis undergoing aortofemoral bypass (AFB) to treat aortoiliac occlusive disease. Given the high reported graft patency rates with superficial femoral vein (SFV) grafts performed because of aortic graft infection, we evaluated the role of SFV grafts for AFB as primary therapy for premature atherosclerosis in a case-control study.
  
  
  METHODS
  Over 10 years 31 patients aged 55 year or younger underwent AFB with use of SFV (V-AFB). Case controls consisted of all patients 55 years of age or younger who underwent AFB with use of Dacron (D-AFB) during the same period (n = 80). In all cases this was the initial therapy (no repeat operations). The two groups were well matched for age, sex, weight, preoperative ankle-brachial index, and the comorbid conditions of smoking, coronary artery disease, chronic obstructive pulmonary disease, hyperlipidemia, hypertension, and renal insufficiency. There were more patients with diabetes in the V-AFB group (34% vs 16%; P =.05). Patients in the V-AFB group had more advanced disease, and the surgical indication was more frequently critical ischemia compared with the D-AFB group (90% vs 46%; P <.001).
  
  
  RESULTS
  There was only one perioperative death in each group. There were no differences in cardiac, pulmonary, or gastrointestinal complications. However, fasciotomy occurred more frequently with V-AFB (44% vs 1%; P <.001). Surgery time was longer with V-AFB (7.3 vs 4.5 hours; P <.001). Despite these short-term drawbacks, V-AFB proved superior at long-term follow-up. The 5-year primary patency rate was significantly higher with V-AFB than with D-AFB (100% vs 56%; P =.013). There was also a trend for higher limb salvage at 5 years (90% vs 62%). Four graft infections occurred with D-AFB, and none with V-AFB (P =.32).
  
  
  CONCLUSIONS
  AFB performed with SFV grafts is a far more durable operation than standard D-AFB in young patients with aortoiliac occlusive disease. However, V-AFB is far more likely to require lower extremity fasciotomy, and takes almost twice as long to perform.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA. Markjackson@ghs.org
authors.forename: Mark R
authors.initials: MR
authors.lastname: Jackson
authors.forename: Ahsan T
authors.initials: AT
authors.lastname: Ali
authors.forename: Christopher
authors.initials: C
authors.lastname: Bell
authors.forename: J Gregory
authors.initials: JG
authors.lastname: Modrall
authors.forename: M Burress
authors.initials: MB
authors.lastname: Welborn
authors.forename: Eva
authors.initials: E
authors.lastname: Scoggins
authors.forename: R James
authors.initials: RJ
authors.lastname: Valentine
authors.forename: Victor J
authors.initials: VJ
authors.lastname: D'Addio
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Clagett
mesh_terms: D000367:Age Factors; D001018:Aortic Diseases / Q000601:surgery; D001161:Arteriosclerosis / Q000601:surgery*; D001672:Biocompatible Materials / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005268:Femoral Vein / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D011093:Polyethylene Terephthalates