Comparison of conduit patency and role of anticoagulants in longitivtiy of prosthetic graft versus autologous saphenous vein for below knee bypass grafting in critical limb ischemia

Dr. Nishant Singh Chandel; Dr. Krishnakant Sahu

Volume : X, Issue : III, March - 2020

Comparison of conduit patency and role of anticoagulants in longitivtiy of prosthetic graft versus autologous saphenous vein for below knee bypass grafting in critical limb ischemia

Dr. Nishant Singh Chandel, Dr. Krishnakant Sahu

Abstract :

Background— As established fact the autogenous vein is the conduit of choice in below–knee arterial bypasses . However, with availability of newer prosthetic grafts and usage of anti–platelets and anticoagulants , the results of these prosthesis‘s are also improving. so much so that in case of non availability of good GSV or malnourished patients where wound healing could be a concern prosthetic grafts can be used reasonably well. We also compared the outcomes of below–knee prosthetic versus autologous vein bypass grafts with different anti–platelets and anti–thrombotic medicines combinations to find out whether the prosthesis performance improves with anticoagulants usage and whether the addition of anticoagulants to anti–platelets is causing more bleeding complications in these patients so much that they are to be used with caution. Methods— For this study, we utilised treatment data of Department of CardioVascular and Thoracic Surgery ,Pt. J.N.M. Medical College Raipur. we studied 70 patients, Single surgeon experience. We included patients who underwent open below knee bypass procedure for critical limb ischemia (claudication/ rest pain/ non healing ulcers/ gangrenous changes) between January 1, 2018 and December 31, 2019. Our analysis was limited to patients whose graft origins were the ipsilateral iliac or femoral arteries and whose targets were the below–knee popliteal or tibial arteries. We analysed the results by evaluating the Graft Patency at 1 year, major amputation at 1 year, bleeding complications, association of bleeding complications to the combination of anti–platelets + anticoagulation. we also evaluated the patency at 1 year in relation to the distal anastomotic sites ( popliteal or infra popliteal ) and amputation in relation to the distal targets for bypass to understand that the disease load has any significance in the patency and limb salvage in patients of lower limb ischemia. Results — A total of 70 patients who underwent open below knee bypass procedure for critical limb ischemia were analysed; 35 patients (50%) received GSV and 35 patients (50%) received a prosthetic conduit. There was no significant difference in primary patency due to Gender (Male 84.3%, Female 15.7%), Diabetes Mellitus (GSV 20%, Prosthetic 14.3%), Hypertension (GSV 31.4%, Prosthetic 45.7%) & Tobacco addition (GSV 100%, Prosthetic 94.3%). Baseline characteristics were similar among groups with the popliteal artery (54.3%) and infra popliteal arteries. i.e. tibioperoneal trunk (27.1%), Anterior Tibial (4.3%) and posterior tibial (14.3%). We found no significant difference in primary graft patency (77% vs 71%, P = ) or major amputation rates (8.5% vs 17%, P = ) between GSV and Prosthetic conduit. The prosthetic graft patency was more when the anti platelets were combined with anticoagulants. Saphenous vein graft patients did well even with anti platelets single or combination. Bleeding complications were more common in the prosthetic group with anti platelets with anticoagulants. Conclusions— Although limited in size, our study demonstrates that, with appropriate patient selection and anti–thrombotic therapy, 1–year outcomes for below–knee prosthetic bypass graft can be comparable to those for greater saphenous vein conduit.Though the study does not challenge the superiority of vein graft for below knee bypass grafting , but in certain cases where needed prosthetic graft are definitely comparable in performance