Heparin-bonded expanded polytetrafluoroethylene graft for infragenicular bypass: five-year results.
OBJECTIVE
This study assessed five-year results with a heparin-bonded expanded polytetrafluoroethylene (ePTFE) graft (GORE PROPATEN Vascular Graft) used in infragenicular bypasses in patients with peripheral arterial disease (PAD) with no available autologous vein for grafting.


METHODS
A retrospective review was conducted of the records of the 75 patients given a heparin-bonded ePTFE graft in 2003 to 2007 and in whom a femoropopliteal 3 (FP 3; distal anastomosis below the knee articulation) or femorocrural (FC) anastomosis was performed. Graft patency rates were determined by life-table analysis.


RESULTS
Most patients (88%) had previously been treated for PAD (Rutherford category 4 to 6 in 91% of patients overall); 31% had renal insufficiency; and 55% had only one patent run-off vessel. Three major procedure-related adverse events occurred within 30 days postoperatively: one death from congestive heart failure, one hemorrhage, and one graft infection. The 1-, 2-, 3-, 4-, and 5-year primary patency rates were, respectively, 77.3%, 71.4%, 71.4%, 71.4%, and undeterminable for the FP 3 bypasses and 64.4%, 56.8%, 49.7%, 49.7%, and 49.7% for the FC bypasses. The 1-, 2-, 3-, 4-, and 5-year secondary patency rates were, respectively, 87.7%, 82.5%, 82.5%, 82.5%, and undeterminable for the FP 3 bypasses and 87.1%, 78.0%, 71.5%, 71.5%, and 71.57% for the FC bypasses. The major amputation rate was 16% or limb salvage was 84% at five years.


CONCLUSIONS
The heparin-bonded ePTFE graft provided good long-term results in infragenicular bypasses in patients with severe PAD.
Lösel-Sadée
H
H
Department of Vascular Surgery, Sana Kliniken Düsseldorf, Düsseldorf, Germany. h.loesel-sadee@sana-duesseldorf.de
Alefelder
C
C
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D005260:Female; D006493:Heparin; D006801:Humans; D015993:Life Tables; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene; D006493:Heparin