Is a vein patch worthwhile for femoropopliteal bypass with ePTFE grafts?

Abstract

One of the factors contributing to late graft occlusion after peripheral arterial bypass with prosthetic grafts is anastomotic intimal hyperplasia. The purpose of this study was to evaluate, experimentally and clinically, the effect of placing a vein patch over the site of distal anastomosis of a ePTFE graft in peripheral arterial bypass (DAPP). After heparinization, the infrarenal abdominal aorta in 14 beagle dogs was resected, and an ePTFE graft was interposed between the resected ends. The dogs were divided into a control group without DAPP and a DAPP group. These animals were killed 3 months after surgery. A total of 89 femoropopliteal bypasses using ePTFE grafts, 71 patients were divided into two groups for analysis; namely, a direct suture group without DAPP being the DS group (n = 62 limbs) and a DAPP group with DAPP (n = 27 limbs). The mean follow-up period was 1010 days in the DS group and 302 days in the DAPP group. All the grafts were patent in both groups of dogs. The thrombus adhering to the entire intraluminal surface of the graft defined as the mean thrombus-covering ratio, in the DAPP group was significantly less than that in the control group, although there were no significant differences in the length of proximal or distal intimal ingrowth into the ePTFE grafts between the two groups. The maximal intimal thickness did not differ significantly between the control group and the DAPP group, at 541 ± 349 μm and 353 ± 76 μm, respectively. The 1- and 3-year cumulative patency rates of femoropopliteal by-passes were 86% and 71%, respectively, in the DS group, whereas they were both 91% in the DAPP group. Although the numbers of subjects in this study was too limited for a final evaluation, the trend was unmistakable. The findings of this study indicate that DAPP may improve the cumulative patency of femoropopliteal bypasses with ePTFE grafts.