PMID- 34644653
OWN - NLM
STAT- MEDLINE
DCOM- 20220228
LR  - 20220228
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 79
DP  - 2022 Feb
TI  - Evaluation of Long-Term Outcomes of Femoropopliteal Bypass Surgery in Patients 
      With Chronic Limb-Threatening Ischemia in an Endovascular Era.
PG  - 191-200
LID - S0890-5096(21)00652-X [pii]
LID - 10.1016/j.avsg.2021.06.046 [doi]
AB  - BACKGROUND: To investigate the long-term outcomes of femoropopliteal bypass 
      surgery in patients with chronic limb-threatening ischemia (CLTI) and 
      TransAtlantic Inter-Society Consensus II (TASC II), type D (TASC D) 
      femoropopliteal disease. METHODS: A retrospective analysis was performed for all 
      consecutive patients undergoing above-knee (AK) femoropopliteal bypass surgery at 
      an academic vascular centre between January 2007 and March 2019. Patients with 
      claudication (IC) and patients with CLTI were included. Patency rates and freedom 
      from major adverse limb events (MALE) after 5 years were analysed. RESULTS: In 
      total, 432 femoropopliteal grafts were performed. Indications for surgery were 
      claudication and CLTI in 232 (53.7%) and 200 (46.3%) patients, respectively. 
      Graft material was autologous vein in 186 patients (43.1%), 
      polytetrafluoroethylene (PTFE) in 128 patients (29.6%), and heparin-bonded 
      expanded polytetrafluoroethylene (HePTFE) in 118 patients (27.3%). At the 5-year 
      follow-up, the primary patency rate was 58.1% and 58.3% in patients with CLTI and 
      claudication, respectively. Secondary patency rates were 74.1% and 68.6%, 
      respectively. Freedom from MALE was 64.5% and 61.9%, respectively. Analyses of 
      graft material in the CLTI group showed that, at 5 years, autologous vein grafts 
      had better long-term patency rates than PTFE and HePTFE grafts. At 5 years, the 
      primary and secondary patency rate for autologous vein grafts were 63.2% (P= 
      0.324) and 83.2% (P = 0.020), respectively. Freedom from MALE was 72.0% with the 
      use of autologous vein grafts, 47.9% using PTFE and, 52.9% using HePTFE, 
      respectively (P= 0.021). CONCLUSIONS: Our study shows that femoropopliteal bypass 
      surgery in patients with TASC D lesions is safe and effective in the long term. 
      Autologous vein grafts remain the first choice for patients with CLTI, also for 
      bypasses in AK position. However, prosthetic grafts in AK the position are an 
      acceptable alternative for revascularisation when the saphenous vein is not 
      available.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Betz, Thomas
AU  - Betz T
AD  - Department of Vascular Surgery, Barmherzige Bruder Hospital, Regensburg, Germany. 
      Electronic address: thomas.betz@barmherzige-regensburg.de.
FAU - Ingolf, Toepel
AU  - Ingolf T
AD  - Department of Vascular Surgery, Barmherzige Bruder Hospital, Regensburg, Germany.
FAU - Markus, Steinbauer
AU  - Markus S
AD  - Department of Vascular Surgery, Barmherzige Bruder Hospital, Regensburg, Germany.
FAU - Florian, Zeman
AU  - Florian Z
AD  - Centre for Clinical Studies, University Medical Center, Regensburg, Germany.
FAU - Christian, Uhl
AU  - Christian U
AD  - Department of Vascular Surgery, Barmherzige Bruder Hospital, Regensburg, Germany.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
DEP - 20211010
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
RN  - 9002-84-0 (Polytetrafluoroethylene)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Blood Vessel Prosthesis
MH  - *Blood Vessel Prosthesis Implantation/adverse effects/instrumentation
MH  - Chronic Disease
MH  - Databases, Factual
MH  - Female
MH  - Femoral Artery/diagnostic imaging/physiopathology/*surgery
MH  - Graft Occlusion, Vascular/etiology/physiopathology
MH  - Humans
MH  - Ischemia/diagnostic imaging/physiopathology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/diagnostic imaging/physiopathology/*surgery
MH  - Polytetrafluoroethylene
MH  - Popliteal Artery/diagnostic imaging/physiopathology/*surgery
MH  - Prosthesis Design
MH  - Retrospective Studies
MH  - Saphenous Vein/*transplantation
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Patency
EDAT- 2021/10/14 06:00
MHDA- 2022/03/01 06:00
CRDT- 2021/10/13 20:08
PHST- 2021/02/13 00:00 [received]
PHST- 2021/06/28 00:00 [revised]
PHST- 2021/06/30 00:00 [accepted]
PHST- 2021/10/14 06:00 [pubmed]
PHST- 2022/03/01 06:00 [medline]
PHST- 2021/10/13 20:08 [entrez]
AID - S0890-5096(21)00652-X [pii]
AID - 10.1016/j.avsg.2021.06.046 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2022 Feb;79:191-200. doi: 10.1016/j.avsg.2021.06.046. Epub 2021 
      Oct 10.