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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES DIABETIC LIMB SALVAGE
Journal of Cardiovascular Surgery 2009 June;50(3):339-43
Heparin-bonded expanded polytetrafluoroethylene graft for infragenicular bypass: five-year results
Lösel-Sadée H., Alefelder C.
Department of Vascular Surgery Sana Kliniken Düsseldorf, Düsseldorf, Germany
Aim. This study assessed five-year results with a heparin-bonded expanded polytetrafluoroethylene (ePTFE) graft (GORE PROPATEN® Vascular Graft) used in infragenicular bypasses in patients with peripheral arterial disease (PAD) with no available autologous vein for grafting.
Methods. A retrospective review was conducted of the records of the 75 patients given a heparin-bonded ePTFE graft in 2003 to 2007 and in whom a femoropopliteal 3 (FP 3; distal anastomosis below the knee articulation) or femorocrural (FC) anastomosis was performed. Graft patency rates were determined by life-table analysis.
Results. Most patients (88%) had previously been treated for PAD (Rutherford category 4 to 6 in 91% of patients overall); 31% had renal insufficiency; and 55% had only one patent run-off vessel. Three major procedure-related adverse events occurred within 30 days postoperatively: one death from congestive heart failure, one hemorrhage, and one graft infection. The 1-, 2-, 3-, 4-, and 5-year primary patency rates were, respectively, 77.3%, 71.4%, 71.4%, 71.4%, and undeterminable for the FP 3 bypasses and 64.4%, 56.8%, 49.7%, 49.7%, and 49.7% for the FC bypasses. The 1-, 2-, 3-, 4-, and 5-year secondary patency rates were, respectively, 87.7%, 82.5%, 82.5%, 82.5%, and undeterminable for the FP 3 bypasses and 87.1%, 78.0%, 71.5%, 71.5%, and 71.57% for the FC bypasses. The major amputation rate was 16% or limb salvage was 84% at five years.
Conclusion. The heparin-bonded ePTFE graft provided good long-term results in infragenicular bypasses in patients with severe PAD.