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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2008 Settembre;15(3):143-8
Will heparin-bonded PTFE replace autologous venous conduits in infrapopliteal bypass?
Peeters P. 1, Verbist J. 1, Deloose K. 2, Bosiers M. 2
1 Department of Cardiovascular and Thoracic Surgery Imelda Hospital, Bonheiden, Belgium
2 Department Vascular Surgery A.Z. Sint-Blasius, Dendermonde, Belgium
Aim. Expanded polytetrafluoroethylene (ePTFE) grafts are commonly used for treatment of infrainguinal arterial occlusive disease. Especially in below-knee (BK) reconstructions, patency is often inferior to the outcome in patients eligible for venous bypass grafting. This study assesses whether the Carmeda® BioActive Surface (CBAS), which employs covalent end-point linkage to retain heparin on the device surface, as it is used on the GORE-TEX® Propaten Vascular Graft (W.L. Gore & Associates, Flagstaff, Arizona) successfully can prolong patency.
Methods. From June 2002 to December 2005, 138 patients (97 men and 41 women; mean age, 73 years) received the Propaten Vascular Graft for 153 infrainguinal bypass procedures. Seventy-five above-knee (AK) and 78 BK (including 37 femoro-crural [FC]) procedures were performed. Follow-up evaluations consisted of clinical examinations, color-flow duplex ultrasound control and distal pulse assessments. Patency and limb salvage rates were assessed by using life-table analyses.
Results. The overall primary and secondary 3-year patency rates were 72.1% and 77.3%, respectively. Three-year primary patency rates for BK bypasses were 74.7% for BK femoropopliteal and 60.4% for femoro-crural bypasses. The corresponding secondary patency rates were 80.2% and 61.6%. The 3-year limb salvage rate in patients with CLI was 85.9%.
Conclusion. These findings show that CBAS-ePTFE bypass grafts appear to give prolonged patency and perform quite well, also in BK application. However, a large prospective randomized trial is mandatory to provide more definitive information about the graft’s patency and limb salvage performance.