Failure of PTFE infrainguinal revascularization: Patterns, management alternatives, and outcome (original) (raw)

Abstract

This review identifies the causes of PTFE infrainguinal bypass graft failure and compares the results of management alternatives. In 322 infrainguinal reconstructions 111 failures occurred over a ten year interval (1978–1988). Sixty-four percent of all failures occurred within the first year, most within the first six months due to severity or progression of distal disease (56%), which suggests that patient selection is an important factor. Only 8% of cases had intimal hyperplasia as a cause of failure without evidence of distal disease progression, and all occurred within the first twelve months. Progression of inflow disease occurred in 25% of instances and was most commonly seen as progression of iliac disease in patients operated upon to relieve claudication and thrombosis of inflow reconstructions in limb salvage patients. Infection was the cause of failure in 5.5% of failed grafts (1.8% of the series) and was associated with multiple reoperations. Management consisted of conservative treatment in 15 cases, with amputation resulting in seven (46%) of these. Operative treatment consisted of (A) thrombectomy with or without patch (N=56); (B) extension with vein (N=12); (C) replacement with vein (N=11); or (D) extension or replacement with PTFE (N=17). Primary patency and limb salvage of secondary procedures at 30 months after the reoperation was (A) 40%/45%; (B) 32%/43%; (C) 55%/72%; and (D) 30%/38%, respectively. Patients in Group C (replacement with vein) had an 88% 30-month patency when this was the first procedure after the failure, with limb salvage in all cases. We conclude that vein replacement after failure of a PTFE bypass is the best management alternative and is best done as the first attempt following failure.

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References

  1. DE WEESE JA, ROB CG. Autogenous venous grafts ten years later.Surgery 1977;82:775–784.
    Google Scholar
  2. WATELET J, CHAEYSSON E, POELS D, et al. In situ versus reversed saphenous vein for femoropopliteal bypass: a prospective randomized study of 100 cases.Ann Vasc Surg 1986;1:441–452.
    Google Scholar
  3. TAYLOR LM Jr, EDWARDS JM, PORTER JM. Present status of reversed vein bypass: long-term results of a modern series.J Vasc Stag 1990;11:193–206.
    Google Scholar
  4. DARLING RC, LINTON RR. Durability of femoropopliteal reconstructions.Am J Surg 1972;123:472–479.
    Article PubMed Google Scholar
  5. SZILAGYI DE, HAGEMAN JH, SMITH RS, et al. Autogenous vein grafting in femoropopliteal atherosclerosis: the limits of its effectiveness.Surgery 1979;36:836–851.
    Google Scholar
  6. O'DONNELL TF, FARBER SP, RICHMOND DM, et al. Above knee polytetrafluoroethylene femoropopliteal bypass graft: Is it a reasonable alternative to the below knee reversed autogenous vein graft?Surgery 1983;94:26–31.
    PubMed Google Scholar
  7. KENT KC, WHITTEMORE AD, MANNICK JA. Shortterm and mid-term results of all autogenous tissue policy for infrainguinal reconstruction.J Vasc Surg 1989;9:107–114.
    Article PubMed Google Scholar
  8. QUINONES-BALDRICH WJ, BUSUTTIL RW, BAKER JD, et al. Is the preferential use of polytetrafluoroethylene graft for femoropopliteal bypass justified?J Vasc Surg 1988;8:219–228.
    Article PubMed Google Scholar
  9. PRENDIVILLE EJ. YEAGER A, O'DONNELL TF, et al. Long-term results with the above knee popliteal expanded polytetrafluoroethylene graft.J Vasc Surg 1990;11:517–524.
    Article PubMed Google Scholar
  10. ROSEN RC, JOHNSON WC, BUSH HL, et al. Staged infrainguinal revascularization: initial prosthetic above knee bypass followed by a distal vein bypass for recurrent ischemia: a valid concept for extending limb salvage.Am J Surg 1986;152:224–230.
    Article PubMed Google Scholar
  11. RUTHERFORD RB, FLANIGAN DP, GUPTA SK, et al. Suggested standard for reports dealing with lower extremity ischemia.J Vasc Surg 1986;4:80–94.
    Article PubMed Google Scholar
  12. EDWARDS JE, TAYLOR LM, PORTER JM. Treatment of failed lower extremity bypass graft with new autogenous vein bypass grafting.J Vasc Surg 1990;11:136–145.
    Article PubMed Google Scholar
  13. FLINN WR, ROHRER MJ, YAO JST, et al. Improved long-term patency of infragenicular polytetrafluoroethylene grafts.J Vasc Surg 1988;7:685–690.
    Article PubMed Google Scholar
  14. KRETSCHMER G, WENZL E, PIZA F, et al. The influence of anticoagulant treatment on the probability of function in femoropopliteal vein bypass surgery: analysis of a clinical series (1970–1985): an interim evaluation of a controlled clinical trial.Surgery 1987;102:453–459.
    PubMed Google Scholar
  15. LIEKWEG WG Jr, GREENFIELD LJ. Vascular prosthetic infections: collected experience and results of treatment.Surgery 1977;81:335–342.
    PubMed Google Scholar
  16. EHRENFELD KW. WILBUR BG, OLCOTT CN, et al. Autogenous tissue reconstruction in the management of infected prosthetic grafts.Surgery 1979;85:82–92.
    PubMed Google Scholar
  17. WHITTEMORE AD, CLOWES AW, COUCH NP, et al. Secondary femoropopliteal reconstruction.Ann Surg 1981;193:35–42.
    PubMed Google Scholar
  18. ASCER E, COLLIER P, GUPTA SK, et al. Reoperation for polytetrafluoroethylene bypass failure: the importance of distal outflow site and operative technique in determining outcome.J Vasc Surg 1987;5:298–310.
    Article PubMed Google Scholar

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Authors and Affiliations

  1. Section of Vascular Surgery, UCLA Medical Center, 10833 LeConte Avenue, 90024-6904, Los Angeles, California
    William J. Quiñones-Baldrich MD, Alfredo Prego MD, Roberto Ucelay-Gomez MD, Candace L. Vescera RN & Wesley S. Moore MD

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  1. William J. Quiñones-Baldrich MD
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  2. Alfredo Prego MD
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  3. Roberto Ucelay-Gomez MD
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  4. Candace L. Vescera RN
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  5. Wesley S. Moore MD
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Quiñones-Baldrich, W.J., Prego, A., Ucelay-Gomez, R. et al. Failure of PTFE infrainguinal revascularization: Patterns, management alternatives, and outcome.Annals of Vascular Surgery 5, 163–169 (1991). https://doi.org/10.1007/BF02016750

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