Impact of Adjunct Femoral Patch Reconstruction on Graft Patency after Below the Knee Popliteal Bypass Implantation
Journal Title: International Journal of Vascular Surgery and Medicine - Year 2016, Vol 2, Issue 1
Abstract
Introduction: Acknowledging the superior long term patency of infrainguinal saphenous bypass to distal popliteal artery, debate continues regarding the choice of alternative conduits and possible surgical adjuncts to improve inflow and graft salvage. The objective of this retrospective study was to determine the effectiveness of proximal anastomotic patch as adjunct to open surgical below the knee popliteal revascularization. Material and Methods: In a series of 132 distal popliteal bypass operations 63 non-reversed vein, 18 in situ vein and 51 Omniflow bypass conduits were used. Proximal anastomotic patch was applied in overall 28 patients: 19% in the non-reversed (12 patients), 50% in the in situ group (9 patients) and 13.7% in the Omni flow group (7 patients). Results: The reintervention rate was 7.9% in the non-reversed, 33.3% in the in situ and 31.4% in the Omniflow group. The most often complication was the proximal anastomotic stenosis (5.3%), followed by bleeding (3%), infection (1.5%) and distal anastomotic stenosis (1.5%). Patch reconstruction did not decrease incidence of reoperation (21.4% vs. 21.2% in the non-patch group), nor significantly influence bleeding, infection or thrombosis, however it reduced the overall rate of proximal anastomosis stenosis (0% vs. 6.7%, p=) and significantly improved patency rate at 3 years in the in situ group compared to the non-patch group (100% vs. 55.6%, p=0.02). Conclusions: Adjunct proximal anastomotic patch has significantly enhanced primary graft patency rate of the situ femoropopliteal below the knee bypasses and reduced proximal anastomotic stenosis after prosthetic bypass implantation. Non-reversed vein bypasses did not profit from this adjunct neither in terms of patency nor in terms of early complications. Further randomized data is needed to ascertain whether this information translates into improvement in limb survival after in situ venous grafting.
Authors and Affiliations
Andrási Terézia B, Dorner Elke, Kindler Christof, Zenker Dieter, Vahl Christian F, Schöndube Friedrich A
Keywords
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- EP ID EP347091
- DOI 10.17352/2455-5452.000017
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