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International Angiology 2001 March;20(1):90-8

Copyright © 2002 EDIZIONI MINERVA MEDICA

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.