ORIGINAL ARTICLES   

Giornale Italiano di Chirurgia Vascolare 2000 March;7(1):13-23

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: English, Italian

Surgical revascularization of the lower extremities using carbon grafts. Immediate and medium-term results

Dordoni L., Chiesa R., Melissano G.

From the Vascular Surgery Division Vita e Salute University San Raffaele Hospital, Milan, Italy

Aims. ­This pros­pec­tive, non-ran­dom­ised ­study is ­designed to ­assess the ­short and ­medium-­term ­results of ­using Car­bo­graft® ­carbon-­coated poly­ester vas­cular pros­theses in the sur­gical revas­cu­lar­isa­tion of the ­lower extrem­ities.
­Methods. ­Between Jan­uary 1997 and Sep­tember 1998 60 ­patients (43 ­male, 15 ­female, ­mean age 68.2 ­years) ­were mon­i­tored ­after ­femoro-pop­li­teal ­bypass pro­ce­dures ­using Car­bo­graft® pros­theses. The indi­ca­tion to sur­gery was inval­i­dating claud­i­ca­tion in 65% and crit­ical ­ischaemia in 35% of ­cases. All ­patients ­were sub­jected to pre­op­er­a­tive angio­graphy ­which ­revealed ­optimum run-off in 11 ­cases (18.3%), ­good run-off in 4 (68.4%) and min­imal run-off in 8 (13.3%). A suprag­e­nic­ular femor­o­pop­li­teal ­bypass oper­a­tion was there­fore per­formed on 49 ­patients (81.7%) and a sub­ge­nic­ular pro­ce­dure on 11 (18.3%).
­Results. ­Mean ­follow-up ­lasted 314±207 ­days. ­Early com­pli­ca­tions (­medium 30 ­days) ­included 5 ­cases of ­graft throm­bosis (8.5%) ­requiring sur­gery and 1 ­case (1.7%) of ­aseptic per­i­pros­thetic effu­sion ­around the ­graft. Tar­dive com­pli­ca­tions ­included 8 ­cases (13.1 pt/yr) of ­graft throm­bosis ­caused by sten­osis of ­distal anas­tom­osis and ­treated by PTA and 2 ­cases (3.3% pt/yr) of ­graft infec­tion. ­There ­were no per­i­op­er­a­tive ­deaths. The prob­ability of pri­mary ­patency at one ­year was ­assessed ­using the ­Kaplan-­Meier ­method and ­came to 70.0±7.1% (67.9±8.3% for suprag­e­nic­ular ­bypass ­cases and 80.2±12.6% for sub­ge­nic­ular pro­ce­dures). The sec­on­dary ­patency ­figure was 88.8±4.4%. A sta­tis­ti­cally sig­nif­i­cant dif­fer­ence was ­noted in pri­mary ­patency ­between ­patients ­with ­good/excel­lent and ­patients ­with ­poor run-off: the pri­mary ­patency ­rates ­were 76.1±7.3% and 35.7±17.5%, respec­tively.
Con­clu­sions. The sat­is­fac­tory ­results ­achieved in ­this ­series jus­tify ­future ran­dom­ised clin­ical ­studies ­designed to con­firm the ­long-­term advan­tages of ­using Car­bo­graft® pros­theses in ­infra-­inguinal revas­cu­lar­isa­tion pro­ce­dures.