title: Factors Affecting Long-Term Results of Above-Knee Femoropopliteal Bypass: A Single-Center Contemporary Study.
abstract: BACKGROUND
  The aim of this study was to assess whether individual patients' or bypass characteristics may influence long-term results of prosthetic above-knee femoropopliteal bypasses in patients with claudication in today's endovascular era.
  
  
  METHODS
  Seventy-one consecutivee Expanded Polytetrafluoroethylene (e-PTFE) bypasses were considered. All patients presented a debilitating claudication. Patency of grafts was achieved by Kaplan-Meier method. The association between individual patients' or graft characteristics and primary patency (PP) or secondary patency (SP) was assessed via Cox regression models.
  
  
  RESULTS
  An immediate technical success was achieved in all cases. No patient was lost during follow-up (8-90 months, median = 34 months). The median PP was 48 months. Occlusion occurred in 32 bypasses (45%). Eight (25%) of these were treated conservatively. Fifty-two bypasses (73%) were still patent at the end of follow-up, and 13 (25%) of these had been submitted to one or more surgical revisions. There were 2 graft infections. Of 17 (25%) patients with occluded graft at the end of follow-up, 2 (2.8%) had significant aggravation followed by limb loss. The PP was directly influenced by undetected minor distal anastomosis technical defects (hazard ratio [HR] = 5.89, P value = .000002), popliteal artery size (HR = 0.62, P value = 0.007), and distal anastomosis angle ≥40° (HR = 5.55, P value = .003). The SP was associated strictly to technical defects (HR = 11.08, P value = .000007). Multivariable analyses confirmed the influence of technical defects (HR = 6.42, P value = .000003) and anastomosis angle (HR = 1.05, P value = .009) on PP and that of technical defects on SP (HR = 10.84, P value = .00003). A significantly shorter SP was also observed after a previous failed endovascular treatment on the superficial femoral artery (HR = 3.73, P value = .02).
  
  
  CONCLUSIONS
  An adequate arterial size, an ideal anastomotic angle, and the absence of minor, technical defects have a major role in prosthetic above-knee femoropopliteal bypass long-term outcome. A previous, failed endovascular procedure on the superficial femoral artery could markedly alter the natural history of patients with claudication because this approach seems to have a detrimental effect on long-term outcome of grafts needing surgical revisions.
authors.affiliation: Department of Vascular Surgery, Sandro Pertini Hospital, Rome, Italy f.desantis6@virgilio.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Santis
authors.affiliation: Center for Biomedicine, European Academy of Bolzano (EURAC), Affiliated Institute of the University of Lübeck, Germany.
authors.forename: Cristian
authors.initials: C
authors.lastname: Pattaro
authors.affiliation: Department of Vascular Surgery, Bressanone Hospital, Bressanone, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Mani
authors.affiliation: Center for Biomedicine, European Academy of Bolzano (EURAC), Affiliated Institute of the University of Lübeck, Germany.
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: Pramstaller
authors.affiliation: Department of Interventional Radiology, Sandro Pertini Hospital, Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Loreni
authors.affiliation: Department of Vascular Surgery, Bressanone Hospital, Bressanone, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Martini
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D007558:Italy; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011138:Polytetrafluoroethylene / Q000009:adverse effects; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene
keywords: above-knee femoropopliteal bypass; endovascular treatment; long-term results; natural history; patient with claudication; superficial femoral artery