GRAFT PATENCY FOR VARIOUS SURGICAL TECHNIQUES IN FEMORAL-POPLITEAL REVASCULARIZATION: A COMPARATIVE STUDY

Dr Neeraj Kumar; Dr Anil Kumar; Dr Manish Daas; Dr Ajitesh P Jain; Dr Rakesh Kumar Verma; Dr Vinay Krishna

Volume : IX, Issue : V, May - 2020

GRAFT PATENCY FOR VARIOUS SURGICAL TECHNIQUES IN FEMORAL-POPLITEAL REVASCULARIZATION: A COMPARATIVE STUDY

Dr Neeraj Kumar, Dr Anil Kumar, Dr Manish Daas, Dr Ajitesh P Jain, Dr Rakesh Kumar Verma, Dr Vinay Krishna

Abstract :

Objective: This study is aimed at comp� primary graft patency of the various revascularization techniques and graft materials available for infra–inguinal revascularization. Material and methods : From August 1, 2012, to July 1, 2018, 127 infra–inguinal arterial revascularization procedures were performed. Femoral–popliteal bypass was done in 32(25.20%), below knee popliteal bypass in 45(35.43%), popliteal bifurcation bypass in 23(18.11%), tibial bypass in 15(11.81%) and segmental bypass in 12(9.45%) patients. Autogenous reversed saphenous vein graft was used in 102(80.31%) patients and prosthetic grafts( polytetrafluoroethylene– PTFE) were used in 25(19.69%). Of these 102 patients with saphenous vein graft, 80 patients (62.99%) were grafted with reversed vein, 6(4.72%) patients with in–situ vein and 8 patients (6.30%) were grafted with translocated vein. In remaining 8(6.30%) patients, endarterectomy of the distal anastomosis site was done along with vein grafting. Results : 14 patients (11.02%) failed to patency criteria during follow–up, and 17 patients (13.38%) were lost to follow–up. Early graft failure (in first 6 months) occurred in 2 operations (1.57%), both in endarterectomy patients. Overall graft patency rates were comparable in all procedural configurations, at 12 months (segmental bypass–100%, above knee femoral–popliteal– 96.61%, below knee bypass– 97.57%, bifurcation bypass–95.66%, tibial bypass– 93.33%), at 6 years (segmental bypass–90.90%, above knee femoral–popliteal –93.04%, below knee bypass– 87.33%, bifurcation bypass– 85.64%, tibial bypass– 75.00%). Early patency rates (at 12 months) were 97.28% for reversed vein graft, 100% for prosthetic, in–situ vein graft and translocated vein conduits. Endarterectomy patients showed a lower patency rates , at 6 months 87.50% and 73.20% at 12, 36 and 72 months. Late patency at 3 and 6 years is very similar to each other in all groups. Conclusion: Though autogenous saphenous vein graft appears to provide the best results with regard to long–term patency in all clinical situations, prosthetic graft also appears to provide same advantage if their use is optimally decided.