Effects of Morphology of Distal Anastomosis Immediately After Surgery on Intimal Hyperplasia in Femoropopliteal Bypass Graft
Intimal hyperplasia of the distal anastomosis was studied angiographically in 26 patients (31 limbs) who underwent femoropopliteal bypass graft and had more than 1 year patency.
Mean follow-up was 32 months (range, 12–105 months) for autologous saphenous vein graft (ACV group, 15 cases) and 24 months (range, 12–64 months) for polytetrafluoroethylene graft (EPTFE group, 16 cases). The stenotic rate (SR) was calculated from digital subtraction arteriograms and rounded off to 0, 10, 25, 50 or 75%. SR was measured both immediately after surgery and at follow-up in 7 of 15 cases in the ASV group and in 11 of 16 cases in the EPTFE group. Some stenosis of the distal anastomosis was noted in 8 of 15 cases (53.3%) in the ASV group and in 8 of 16 cases (50.0%) in the EPTFE group. The SR in patients with measurements both immediately after surgery and at follow-up, which was 0% in 6 and 10% in one case immediately after surgery, was 0% in 4 cases, 10% in 2 cases, and 25% in 1 case at follow-up. In the EPTFE group, SR immediately after surgery was 0% in 7, 10% in 2, and 25% in 2 cases of 11 cases with measurements both immediately after surgery and at follow-up. SR at follow-up, however, was 0% in 4, 10% in 3, 50% in 3, and 75% in 1 case.
Technical factors causing stenosis when the anastomosis is created appear to be the primary risk factor for intimal hyperplasia as a cause of late graft failure.
The etiology of femoropopliteal bypass vein or EPTFE graft failure remains to be elucidated fully. Generally speaking, early graft failure usually is attributed to technical problems, and late graft failure to progression of atherosclerosis in native vessels proximal or distal to the graft or intimal hyperplasia at the anastomosis. However, the details of these processes are unknown.
This study examines intimal hyperplasia at the distal anastomosis after femoropopliteal bypass and attempts to determine which factors affect it.
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