Aortofemoral bypass in young patients with premature atherosclerosis: is superficial femoral vein superior to Dacron?
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.
Jackson
Mark R
MR
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA. Markjackson@ghs.org
Ali
Ahsan T
AT
Bell
Christopher
C
Modrall
J Gregory
JG
Welborn
M Burress
MB
Scoggins
Eva
E
Valentine
R James
RJ
D'Addio
Victor J
VJ
Clagett
G Patrick
GP
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
D001672:Biocompatible Materials; D011093:Polyethylene Terephthalates