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Comparison of Precuffed and Vein-Cuffed Expanded Polytetrafluoroethylene Grafts for Infragenicular Arterial Reconstructions:A Case-Matched Study

  • Clinical Research
  • Published:
Annals of Vascular Surgery

Abstract

Distal vein cuff interposition is often added to prosthetic infragenicular arterial reconstruction in an attempt to improve hemodynamics and patency rates. The purpose of this study was to compare the outcome of a precuffed expanded polytetrafluroethylene (ePTFE) graft with a vein-cuffed ePTFE graft for infragenicular bypass. We reviewed the clinical outcome of 77 patients with critical limb ischemia without available autologous vein conduits who underwent arterial reconstruction of 80 limbs to below-knee popliteal or tibioperoneal vessels using either ePTFE precuffed graft (precuffed group, 38 patients 40 limbs) or ePTFE vein-cuffed graft (vein-cuffed group, 39 patient, 40 limbs). Precuffed group patients were enrolled in a prospective cohort study. Vein-cuffed group patients consisted of consecutive case-matched patients operated on during the same study period. End points were primary graft patency and limb salvage rates. There were 42 males and 35 females with a mean age of 73.4 years (range, 44-92 years). Both groups were matched to demographics, risk factors for atherosclerosis, previous ipsilateral reconstruction, and location of the distal anastomosis. Proximal anastomosis was to the common (n = 68) or superficial (n = 12) femoral arteries. Distal anastomosis was to the below-knee popliteal (n = 28), anterior tibial (n = 12), posterior tibial (n = 15) and peroneal (n = 25) arteries. Operative mortality was 1.3%. Graft patency at dismissal was 90% and 95% in the precuffed and vein-cuffed groups, respectively. The mean follow-up was 25.7 months (range, 2.4-61 months). Primary patency rates at 1 and 3 years were 70% and 57% in the precuffed group, and 78% and 54% in the vein-cuffed group (p = 0.32). Limb salvage rates at 1 and 3 years were 97% and 70% in the precuffed group, and 95% and 81 % in the vein-cuffed group (p = 0.49). Overall patient survival at 1 and 3 years was 81 % and 57%, respectively. In this case-control study, results of precuffed ePTFE graft were similar to those obtained with vein-cuffed ePTFE grafts. The precuffed ePTFE graft is an adequate alternative conduit for infragenicular arterial reconstruction in patients with critical limb ischemia and no available autologous veins.

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Reference

  1. FJ Veith SK Gupta E Ascer et al. (1986) ArticleTitleSix-year prospective multicenter randomized comparison of autologous saphenous vein expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions J Vasc Surg 3 104–114 Occurrence Handle10.1067/mva.1986.avs0030104

    Article  Google Scholar 

  2. TF O’Donnell W Mackey JL McCallough et al. (1984) ArticleTitleCorrelation of operative findings with angiographic and non-invasive haemoynamic factors associated with the failure of polytetrafluoroethylene grafts J Vasc Surg 1 136 Occurrence Handle10.1067/mva.1984.avs0010136

    Article  Google Scholar 

  3. JH Miller RK Foreman L Ferguson I Faris (1984) ArticleTitleInterposition vein cuff for anastomosis of prosthesis to small artery Aust N Z J Surg 54 283–285

    Google Scholar 

  4. RC Batson VS Sottiurai CC Craighead (1984) ArticleTitleLinton patch angioplasty: an adjunct to distal bypass with polytetrafluorethylene grafts Ann Surg 199 684–693

    Google Scholar 

  5. MR Tyrrel JH Wolfe (1991) ArticleTitleNew prosthetic venous collar anastomotic technique: combining the best of other procedures Br J Surg 78 1016–1017

    Google Scholar 

  6. RS Taylor A Loh RJ McFarland M Cox JF Chester (1992) ArticleTitleImproved technique for polytetrafluorethylene bypass grafting: long-term results using anastomotic vein patches Br J Surg 79 348–354

    Google Scholar 

  7. RK Fischer TV How IM Toonder et al. (2001) ArticleTitleHarnessing hemodynamic forces for the suppression of anastomotic intimal hyperplasia: the rationale for precuffed grafts Eur J Vasc Endovasc Surg 21 520–528 Occurrence Handle10.1053/ejvs.2001.1365

    Article  Google Scholar 

  8. RK Fisher UJ Kirkpatrick TV How JA Brennan GL Gilling-Smith PL Harris (2003) ArticleTitleThe Distaflo graft: a valid alternative to interposition vein? Eur J Vasc Endovasc Surg 25 235–239 Occurrence Handle10.1053/ejvs.2002.1840

    Article  Google Scholar 

  9. JM Panneton LM Hollier JM Hofer InstitutionalAuthorNamethe Distaflo Trial Investigators. (2004) ArticleTitleMulticenter randomized prospective trial comparing a pre-cuffed PTFE graft and a vein cuffed PTFE graft for infragenicular arterial bypass Ann Vasc Surg 18 199–206 Occurrence Handle10.1007/s10016-004-0012-y

    Article  Google Scholar 

  10. RB Rutherford JD Baker C Ernst et al. (1997) ArticleTitleRecommended standards for reports dealing with lower extremity ischemia: revised version J Vasc Surg 26 517–538

    Google Scholar 

  11. S Raptis JH Miller (1995) ArticleTitleInfluence of a vein cuff on polytetrafluoroethylene grafts for primary femoropopliteal bypass Br J Surg 82 487–491

    Google Scholar 

  12. PA Stonebridge RJ Prescott CV Ruckley InstitutionalAuthorNamethe Joint Vascular Research Group (1997) ArticleTitleRandomized trial comparing infrainguinal polytetrafluorethylene bypass grafting with and without vein interposition cuff at the distal anastomosis J Vasc Surg 26 543–550

    Google Scholar 

  13. WD Suggs HF Henriques RG DePalma (1988) ArticleTitleVein cuff interposition prevents juxta-anastomotic neointimal hyperplasia Ann Surg 207 717–723

    Google Scholar 

  14. JJ Norberto AN Sidawy KS Trad et al. (1995) ArticleTitleThe protective effect of vein cuffed anastomoses is not mechanical in origin J Vasc Surg 21 558–666

    Google Scholar 

  15. HS Bassiouny S White S Glagov et al. (1992) ArticleTitleAnastomotic intimal hyperplasia: mechanical injury or flow induced J Vasc Surg 15 708–717 Occurrence Handle10.1067/mva.1992.33849

    Article  Google Scholar 

  16. MR Tyrrel JHN Wolfe (1997) ArticleTitleMyointimal hyperplasia in vein collars for ePTFE grafts Eur J Endovasc Surg 14 33–36

    Google Scholar 

  17. M Kissin N Kansal PJ Pappas et al. (2000) ArticleTitleVein interposition cuffs decrease hyperplastic response of polytetrafluoroethylene bypass grafts J Vasc Surg 31 69–83

    Google Scholar 

  18. TV How CS Rowe GL Gilling-Smith P Harris (2000) ArticleTitleInterposition vein cuff anastomosis alters wall shear stress distribution in the recipient artery J Vasc Surg 31 1008–1017 Occurrence Handle10.1067/mva.2000.105961

    Article  Google Scholar 

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Acknowledgments

The authors gratefully acknowledge the assistance of Mrs. Rhonda Brincks for manuscript preparation and Stephen Cha, MS, for statistical analysis.

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Authors and Affiliations

  1. Division of Vascular Surgery, Mayo Clinic, Rochester, MN

    Gustavo S. Oderich MD, Jean M. Panneton MD, Marineh Yagubyan MD, Thomas C. Bower MD, Jan Hofer RN, Audra A. Noel MD, Timothy Sullivan MD, Manju Kalra MBBS, Kenneth J. Cherry Jr MD & Peter Gloviczki MD

  2. Vascular and Transplant Specialists, Eastern Virginia Medical School, Norfolk, VA

    Jean M. Panneton MD

Authors
  1. Gustavo S. Oderich MD
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  2. Jean M. Panneton MD
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  3. Marineh Yagubyan MD
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  4. Thomas C. Bower MD
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  5. Jan Hofer RN
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  6. Audra A. Noel MD
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  7. Timothy Sullivan MD
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  8. Manju Kalra MBBS
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  9. Kenneth J. Cherry Jr MD
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  10. Peter Gloviczki MD
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Corresponding author

Correspondence to Jean M. Panneton MD.

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Oderich, G.S., Panneton, J.M., Yagubyan, M. et al. Comparison of Precuffed and Vein-Cuffed Expanded Polytetrafluoroethylene Grafts for Infragenicular Arterial Reconstructions:A Case-Matched Study. Ann Vasc Surg 19, 49–55 (2005). https://doi.org/10.1007/s10016-004-0152-0

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  • DOI: https://doi.org/10.1007/s10016-004-0152-0

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