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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2001 March;20(1):90-8


lingua: Inglese

Antiplatelet and anticoagulant therapy to prevent bypass graft thrombosis in patients with lower extremity arterial occlusive disease

Adam D. J. *, Stonebridge P. A., Belch J. J. F., Murie J. A. *

From the University Departments of Surgery and Medicine, Ninewells Hospital, Dundee and the * Vascular Surgery Unit, Royal Infirmary, Edinburgh, U.K.


The inci­dence of graft fail­ure for above knee femor­o­pop­li­teal ­grafts is ­described by the European Consensus Document on Critical Limb Ischaemia. It ­occurs in approx­i­mate­ly 15% of ­patients when vein is used for the graft­ing pro­ce­dure and in 20% of ­patients when PTFA (poly­tet­ra­flu­o­roe­thy­lene) or other pros­thet­ic mate­ri­al is used. Femorodistal ­grafts have a much poor­er out­come with 45% and 75% fail­ure rates for vein and pros­thet­ic ­grafts, respec­tive­ly. Prevention of pri­mary graft fail­ure and thus the need for sur­gi­cal reinter­ven­tion is of major clin­i­cal and eco­nom­ic impor­tance. Early fail­ure, occur­ring with­in one month of oper­a­tion, is usu­al­ly due to tech­ni­cal error such as poor ­patient selec­tion or oper­a­tive tech­nique. Approximately 10% of graft fail­ures will fall into this time peri­od. When ­grafts throm­bose after two years, pro­gres­sion of ­native ath­ero­scler­o­sis ­either prox­i­mal­ly or dis­tal­ly is the usual cause. This ­accounts for 2-3% of all graft fail­ures each year. The most com­mon time for ­grafts to fail is ­between one month and two years (80% of all fail­ures) and this is the same peri­od in which graft ste­nos­es are now known to devel­op. There are few evi­dence-based rec­om­men­da­tions for the use of phar­mac­o­log­i­cal ­agents in main­tain­ing graft paten­cy fol­low­ing periph­er­al vas­cu­lar sur­gery. This arti­cle ­reviews the evi­dence for or ­against the use of anti­co­ag­u­lant and anti­plate­let ther­a­py for the pre­ven­tion of ­bypass graft throm­bo­sis in ­patients with periph­er­al arte­ri­al occlu­sive dis­ease.

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