Journal «Angiology and Vascular Surgery» • 

2014 • VOLUME 20 • №2

Results of using composite bypass grafts with infragenicular distal anastomosis

Pokrovsky A.V.1, Yakhontov D.I.2

1) Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health,
2) Chair of Clinical Angiology and Vascular Surgery, Russian Medical Academy of Postgraduate Education under the RF Ministry of Public Health, Moscow, Russia

The authors share herein their experience with composite bypass grafts and PTFE synthetic prostheses used for treatment of obliterating diseases of the infrainguinal-segment arteries. The data of the study were based on the outcomes obtained in 92 patients. The authors assessed the condition of the outflow pathways and their effect on patency of composite bypass grafts in the immediate and remote postoperative periods, followed by comparative analysis of the short- and long-term therapeutic outcomes after using composite bypass grafts and PTFE synthetic prostheses in the infragenicular position for femoropopliteal and femorotibial reconstructions, also assessing the effect of the localization of the distal anastomosis on the immediate and remote therapeutic outcomes. Based on the obtained findings it was determined that the immediate results of patency depended upon the state of the outflow pathways and localization of the distal anastomosis. Thus, by the 1st, 3rd and 5th year of follow up patency of transplants in patients with the runoff score less than 7.0 amounted to 78.3%, 21.7% and 4.3%, respectively. Analogous indices of patency in patients with the runoff score equalling or greater than 7.0 amounted to 60.7% and 3.6% for the 1st and 3rd year, respectively. The remote results of patency turned out to depend on the type of a vascular transplant and the state of the outflow pathways and did not depend on the localization of the distal anastomosis. Thus, the remote results of patency for the composite bypass graft for the 1st, 3rd and 5th year of follow up amounted to 74.5%, 19.6% and 5.9%, respectively, versus 60.8% and 8.6% by the first and third year for the PTFE prosthesis. The limb salvage rate at the same terms for the composite bypass graft amounted to 94.1%, 84.3% and 78.4% versus 73.9%, 56.5% and 52.2% for the PTFE prosthesis.

KEY WORDS: obliterating diseases of lower-limb arteries, distal reconstructions, composite bypass graft, autovenous extension, autovenous cuff, polytetrafluoroethylene prosthesis, runoff score value, localization of distal anastomosis.

P. 147

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