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A Journal on Cardiac, Vascular and Thoracic Surgery
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ORIGINAL ARTICLES VASCULAR PAPERS
The Journal of Cardiovascular Surgery 2000 June;41(3):415-21
Reoperation for graft failure of femoropopliteal bypass with externally supported knitted Dacron prosthesis
Mii S., Mori A., Sakata H., Kawazoe N. *
From the Department of Surgery
*Department of Cardiology Nippon Steel Yawata Memorial Hospital Kitakyushu-city, Japan
Background. Aggressive reoperation for failing or failed femoropopliteal (FP) bypass has been affirmative despite graft material. There has been no report regarding results of reoperation for FP bypass with externally supported knitted Dacron prosthesis (EXS). The aim of this study is to justify aggressive reoperation of FP bypass with EXS and to examine risk factors affecting the result of reoperation.
Methods. A retrospective review was performed on 204 patients undergoing 212 FP bypasses (with EXS between January 1982 and December 1997 and 34 FP EXSes of 32 patients underwent reoperation for graft failure until March 1998. The cumulative graft patency (GP) and limb salvage (LS) rate after first reoperation for 34 FP bypass EXS were calculated and the importance of each perioperative factor on GP or LS was estimated by uni- and multivariate analysis.
Results. Reoperated 34 FP EXSes included 12 failing and 22 failed grafts and 14 limbs with failed grafts underwent reoperation for limb salvage. The GP of 34 grafts and LS of 14 limbs rate were 58 and 67% at 2 years, respectively. Univariate analysis identified graft thrombosis (2 years GP; failing graft: failed graft=78: 48%) and continuance of smoking (2 years LS; smoker: non-smoker=43: 100%) as a significant risk factor of GP and LS, respectively, neither of which was significant by multivariate analysis.
Conclusions. Early diagnosis and treatment, before graft thrombosis, can lead to superior durability of GP and discontinuance of smoking is important for LS.