title: Comparison of precuffed expanded polytetrafluorothylene and heparin-bonded polytetrafluorothylene graft in crural bypass.
abstract: BACKGROUND
  The purpose of this study was to evaluate early and midterm results of tibial bypasses comparing precuffed expanded polytetrafluoroethylene (PTFE) graft (Distaflo) and heparin-bonded PTFE graft (Propaten) with a distal vein patch.
  
  
  METHODS
  This is a retrospective cohort analysis evaluating patients who underwent PTFE femorocrural bypasses between April 2004 and December 2010 at the Vascular Surgery Division of the Poliambulanza Foundation Hospital (Brescia, Italy). Results were analyzed in terms of primary and secondary graft patency, limb salvage, and survival with univariate (Kaplan-Meier curves and log-rank test) and multivariate (Cox regression) analyses.
  
  
  RESULTS
  After analyzing many patients, we found 79 femorotibial bypass PTFE grafts. We used a Propaten graft and vein patch in 40 patients and a Distaflo graft in 39 patients. The two groups were comparable for main risk factors, except for age. Indication for surgical revascularization was critical limb ischemia in all patients. In 54 cases (68%), it was a redo bypass because of a previously failed revascularization. Perioperative mortality within 30 days from intervention was 2.5%, whereas overall mortality during follow-up was 29%, with a 36-month survival rate of 58% (95% confidence interval [CI]: 0.44-0.77) on life table analysis. We observed a significant difference between two groups in terms of survival at 36 months (Propaten: 0.84 [95% CI: 0.69-1]; Distaflo: 0.21 [95% CI: 0.07-0.63]; P < 0.001; 95% CI: 0.07-0.63; odds ratio [OR]: 0.21). At 24 months, the two groups (Propaten vs. Distaflo) were equivalent in terms of primary patency (Propaten: 0.33 [95% CI: 0.21-0.53]; Distaflo: 0.47 [95% CI: 0.32-0.70]; P = 0.793), secondary patency (Propaten: 0.36 [95% CI: 0.23-0.57]; Distaflo: 0.49 [95% CI: 0.33-0.72]; P = 0.855), and limb salvage (Propaten: 0.65 [95% CI: 0.51-0.84]; Distaflo: 0.57 [95% CI: 0.41-0.79]; P = 0.18). At Cox regression analysis, age of >80 years (P < 0.04; 95% CI: 0.23-0.95; OR: 0.47), peroneal artery distal anastomosis (P < 0.04; 95% CI: 1.04-5.62; OR: 2.42), simultaneous adjunctive procedures (P < 0.02; 95% CI: 1.21-17.74; OR: 4.64), and redo bypass (P < 0.05; 95% CI: 1-6.26; OR: 2.5) were associated with long-term poorer primary patency rates. Postoperative treatment with warfarin therapy compared with antiplatelet therapy was independently associated with better secondary patency (P < 0.04; 95% CI: 0.20-0.95; OR: 0.44) and limb salvage (P < 0.03; 95% CI: 0.11-0.87; OR: 0.32) rates.
  
  
  CONCLUSIONS
  Distaflo and Propaten with a distal vein patch in our experience have similar patency and limb salvage results, although further randomized and larger studies are necessary. Postoperative anticoagulation therapy seems better than antiplatelet therapy in terms of patency and limb salvage rate.
authors.affiliation: Division of Vascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy. raffaello.bellosta@poliambulanza.it
authors.forename: Raffaello
authors.initials: R
authors.lastname: Bellosta
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Natalini
authors.forename: Luca
authors.initials: L
authors.lastname: Luzzani
authors.forename: Claudio
authors.initials: C
authors.lastname: Carugati
authors.forename: Antonio
authors.initials: A
authors.lastname: Sarcina
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D020099:Coated Materials, Biocompatible; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D016909:Tibial Arteries / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation
chemical_list: D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D010975:Platelet Aggregation Inhibitors; D011138:Polytetrafluoroethylene; D006493:Heparin