A retrospective cohort comparison of expanded polytetrafluorethylene to autologous vein for vascular reconstruction in modern combat casualty care.
BACKGROUND
Reconstruction of vascular injury often requires use of a conduit, either autologous vein (AV) or expanded polytetrafluorethylene (ePTFE). The most common anatomic locations for and durability of ePTFE as an adjunct to vascular repair in the combat setting are unknown. The objectives of this study were to characterize the anatomic locations of use of ePTFE during the wars in Afghanistan and Iraq and to compare its effectiveness to AV.


METHODS
US service personnel undergoing vascular repair (2002-2012) were identified. Patients in whom ePTFE was used as an interposition conduit (n = 25) were matched with similar patients who received AV (n = 24) reconstruction. Injury and operative factors were assessed, and freedom from graft-related complication was quantified using Kaplan-Meier log-rank test.


RESULTS
There was no difference between ePTFE and AV with regard to age, injury severity, or mangled extremity severity score. Follow-up for the ePTFE and AV groups was 71 and 62 months, respectively. In the cohort there was an apparent but not significantly greater freedom from graft-related complication for AV compared with ePTFE (65% vs. 17%; P = 0.13). In the carotid, subclavian, and axillary artery positions, ePTFE performed equal to AV with no apparent difference in freedom from graft-related complications (P = 0.90). However, in the periphery, AV demonstrated greater 8-year freedom from graft-related complication than ePTFE (77% vs. 31%, P = 0.044).


CONCLUSIONS
AV is a more durable conduit than ePTFE in repair of wartime extremity vascular injury, whereas ePTFE is effective and durable in the carotid, subclavian, and axillary locations.
Department of Surgery, San Antonio Military Medical Center, San Antonio, TX; The United States Army Institute of Surgical Research, San Antonio, TX.
J Devin B
JD
Watson
Department of Surgery, San Antonio Military Medical Center, San Antonio, TX; The United States Army Institute of Surgical Research, San Antonio, TX.
Robert
R
Houston
The United States Army Institute of Surgical Research, San Antonio, TX; The Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
Jonathan J
JJ
Morrison
Department of Surgery, San Antonio Military Medical Center, San Antonio, TX.
Shaun M
SM
Gifford
The United States Army Institute of Surgical Research, San Antonio, TX; The Norman M. Rich Department of Surgery, The Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: todd.e.rasmussen.mil@mail.mil.
Todd E
TE
Rasmussen
D000328:Adult; D055826:Afghan Campaign 2001-; D064592:Autografts; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D053208:Kaplan-Meier Estimate; D008297:Male; D008887:Military Medicine; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014680:Veins / Q000637:transplantation*; D055815:Young Adult
D011138:Polytetrafluoroethylene