title: A comparison of femorocrural bypasses performed with modified heparin-bonded expanded polytetrafluorethylene grafts and those with great saphenous vein grafts to treat critical limb ischemia.
abstract: BACKGROUND
  The purpose of this study was to evaluate our results involving femorocrural bypasses by comparing heparin-bonded expanded polytetrafluoroethylene (HePTFE) graft (Propaten) modified with handmade distal compliant HePTFE cuffs (mHePTFE graft) to great saphenous vein (GSV) graft.
  
  
  METHODS
  A retrospective study involving 74 femorocrural bypasses performed from January 2010 to May 2013 at a single institution was carried out. The indication for revascularization was critical limb ischemia (Rutherford stages 4-6. Forty-one femorocrural bypasses were created in 37 patients with unavailable GSVs using modified ringed HePTFE grafts with a handmade distal radial stretch HePTFE cuff to reduce the mismatch compliance between the graft and the artery wall. Thirty-three femorocrural bypasses were created using a reversed GSV graft. The results were analyzed in terms of primary graft patency, limb salvage, and patient survival using univariate (Kaplan-Meier curves and log-rank test) and multivariate (Cox regression) analyses.
  
  
  RESULTS
  The 2 groups were statistically comparable for main risk factors, Rutherford stage, and target artery for distal anastomoses. The run-off anatomy did not significantly differ between the prosthetic and the vein bypass group. The cumulative 30-day operative mortality rate was 2.9%. At 1, 2, and 3 years, the 2 groups were equivalent in primary graft patency (the mHePTFE group: 84%, 80%, and 70%, respectively; the GSV group: 84%,71%, and 71%, respectively; P = 0.93) and were also equivalent in terms of limb salvage (the mHePTFE group: 87%, 87%, and 76%, respectively; the GSV group: 84%, 75%, and 75%, respectively; P = 0.78) and patient survival (the mHePTFE group: 87%, 75%, and 75%, respectively; the GSV group: 87%, 73%, and 65%, respectively; P = 0.86). At Cox regression analysis, only postoperative treatment with warfarin therapy compared with double antiplatelet therapy was independently associated with poorer primary patency (P = 0.003; 95% confidence interval, 1.80-18.00; hazard ratio, 5.7).
  
  
  CONCLUSIONS
  In this retrospective study regarding femorocrural bypasses, the mHePTFE grafts had 1-, 2-, and 3-year primary patency and limb salvage results which were not significantly different from those in the GSV grafts. Additional randomized data and larger studies are needed to confirm these results.
authors.affiliation: Cardiovascular Diseases Department, Vascular and Endovascular Surgery Unit, Infermi Hospital, Rimini, Italy. Electronic address: maxgessaroli53@libero.it.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Gessaroli
authors.affiliation: Cardiovascular Diseases Department, Vascular and Endovascular Surgery Unit, Infermi Hospital, Rimini, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tarantini
authors.affiliation: Cardiovascular Diseases Department, Vascular and Endovascular Surgery Unit, Infermi Hospital, Rimini, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Leone
authors.affiliation: Cardiovascular Diseases Department, Quality and Research Assessment Unit, Infermi Hospital, Rimini, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Fabbri
authors.affiliation: Cardiovascular Diseases Department, Quality and Research Assessment Unit, Infermi Hospital, Rimini, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Panzini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; 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; D016638:Critical Illness; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011138:Polytetrafluoroethylene; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene; D006493:Heparin