ORIGINAL ARTICLES  VASCULAR PAPERS 

The Journal of Cardiovascular Surgery 2000 June;41(3):415-21

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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.