Aim. To compare the differences between medial and intercondylar infragenicular femoropopliteal prosthetic bypasses in terms of their midterm patency and limb salvage rates. Methods. Ninety-three consecutive patients with peripheral arterial disease who underwent a simple distal femoropopliteal bypass using a reinforced polytetrafluorethylene graft were included in this retrospective study. The bypass was constructed in the intercondylar route in 52 of the patients (group A) and in 41 in the medial route (group B). Results. Median observation time of the patients was 12.7 (IQR 4.6-18.5) months. There were 22 and 24 interventional or surgical procedures (angioplasty, stenting, thrombolysis, thrombectomy, or correction of the anastomosis) performed to restore patency of the reconstruction in groups A and B, respectively (p = 0.14). The 20-month primary, assisted, and secondary patency rates and limb salvage rates were 57%, 57%, 81%, and 80% in group A compared to 21%, 23%, 55%, and 82% in group B (p = 0.0012, 0.0052, 0.022, and 0.44, resp.). Conclusion. Despite better primary, assisted, and secondary patency rates in patients with a prosthetic infragenicular femoropopliteal bypass embedded in the intercondylar fossa compared to patients with the medial approach, there is no benefit in terms of the limb salvage rate and the number of interventions required to maintain patency of the reconstruction.

4th Department of Medicine 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Prague Czech Republic

Department of Cardiovascular Surgery 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Prague Czech Republic

Department of Cardiovascular Surgery 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Prague Czech Republic; Department of Cardiovascular Surgery 2nd Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Radiology 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Prague Czech Republic

Zobrazit více v PubMed

Pereira C. E., Albers M., Romiti M., Brochado-Neto F. C., Pereira C. A. B. Meta-analysis of femoropopliteal bypass grafts for lower extremity arterial insufficiency. Journal of Vascular Surgery. 2006;44(3):510–517.e3. doi: 10.1016/j.jvs.2006.04.054. PubMed DOI

Aracil-Sanus E., Mendieta-Azcona C., Cuesta-Gimeno C., Chinchilla-Molina A. Infragenicular bypass graft for limb salvage using polytetrafluoroethylene and distal vein cuff as the first alternative in patients without ipsilateral greater saphenous vein. Annals of Vascular Surgery. 2005;19(3):379–385. doi: 10.1007/s10016-004-0130-6. PubMed DOI

Lauterbach S. R., Torres G. A., Andros G., et al. Infragenicular polytetrafluoroethylene bypass with distal vein cuffs for limb salvage: a contemporary series. Archives of Surgery. 2005;140(5):487–494. doi: 10.1001/archsurg.140.5.487. PubMed DOI

Takagi H., Goto S.-N., Matsui M., Manabe H., Umemoto T. A contemporary meta-analysis of Dacron versus polytetrafluoroethylene grafts for femoropopliteal bypass grafting. Journal of Vascular Surgery. 2010;52(1):232–236. doi: 10.1016/j.jvs.2010.02.010. PubMed DOI

Tuchmann A., Dinstl K. Below-knee femoropopliteal bypass using externally supported polytetrafluoroethylene (PTFE) grafts. Annals of Vascular Surgery. 1989;3(2):177–180. doi: 10.1007/bf03187388. PubMed DOI

Daenens K., Schepers S., Fourneau I., Houthoofd S., Nevelsteen A. Heparin-bonded ePTFE grafts compared with vein grafts in femoropopliteal and femorocrural bypasses: 1- and 2-year results. Journal of Vascular Surgery. 2009;49(5):1210–1216. doi: 10.1016/j.jvs.2008.12.009. PubMed DOI

Sarkar S., Salacinski H. J., Hamilton G., Seifalian A. M. The mechanical properties of infrainguinal vascular bypass grafts: their role in influencing patency. European Journal of Vascular and Endovascular Surgery. 2006;31(6):627–636. doi: 10.1016/j.ejvs.2006.01.006. PubMed DOI

Grus T., Grusova G., Lambert L., Banerjee R., Matecha J., Mlcek M. The influence of the anastomosis angle on the hemodynamics in the distal anastomosis in the infrainguinal bypass: an in-vitro study. Physiological Research. 2016;65(4) PubMed

Grus T., Lindner J., Vidim T., et al. The anastomosis angle is a key to improved long-term patency of proximal femoropopliteal bypass. Annals of Vascular Surgery. 2009;23(5):598–605. doi: 10.1016/j.avsg.2009.06.008. PubMed DOI

Dormandy J. A., Rutherford R. B. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC. Journal of Vascular Surgery. 2000;31(1):S1–S296. doi: 10.1016/s0741-5214(00)81002-2. PubMed DOI

Gregory R. T., Yao J. S. T. The first Gore-Tex femoral-popliteal bypass. Journal of Vascular Surgery. 2013;58(1):266–269. doi: 10.1016/j.jvs.2013.02.246. PubMed DOI

Sterpetti A. V., Sapienza P., Cavallaro A. Distal runoff and the development of degenerative changes in autologous reversed saphenous vein femoropopliteal bypass. Annals of Vascular Surgery. 2011;25(6):766–769. doi: 10.1016/j.avsg.2011.01.006. PubMed DOI

Bassiouny H. S., White S., Glagov S., Choi E., Giddens D. P., Zarins C. K. Anastomotic intimal hyperplasia: mechanical injury or flow induced. Journal of Vascular Surgery. 1992;15(4):708–717. doi: 10.1016/0741-5214(92)90019-5. PubMed DOI

Haruguchi H., Teraoka S. Intimal hyperplasia and hemodynamic factors in arterial bypass and arteriovenous grafts: a review. Journal of Artificial Organs. 2003;6(4):227–235. doi: 10.1007/s10047-003-0232-x. PubMed DOI

Hoedt M., How T., Poyck P., Wittens C. Why patencies of femoropopliteal bypass grafts with distal end-to-end anastomosis are comparable with end-to-side anastomosis. Annals of Thoracic and Cardiovascular Surgery. 2015;21(2):157–164. doi: 10.5761/atcs.oa.14-00121. PubMed DOI PMC

Grus T., Lindner J., Vik K., et al. Particle image velocimetry measurement in the model of vascular anastomosis. Prague Medical Report. 2007;108(1):75–86. PubMed

Panneton J. M., Hollier L. H., Hofer J. M. Multicenter ramdomized prospective trial comparing a pre-cuffed polytetrafluoroethylene graft to a vein cuffed polytetrafluoroethylene graft for infragenicular arterial bypass. Annals of Vascular Surgery. 2004;18(2):199–206. doi: 10.1007/s10016-004-0012-y. PubMed DOI

Khalil A. A., Boyd A., Griffiths G. The Cochrane Collaboration. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons; 2012. Interposition vein cuff for infragenicular prosthetic bypass graft. PubMed PMC

Roll S., Müller-Nordhorn J., Keil T., et al. Dacron® vs. PTFE as bypass materials in peripheral vascular surgery—systematic review and meta-analysis. BMC Surgery. 2008;8, article 22 doi: 10.1186/1471-2482-8-22. PubMed DOI PMC

Stonebridge P. A., Prescott R. J., Ruckley C. V. Randomized trial comparing infrainguinal polytetrafluoroethylene bypass grafting with and without vein interposition cuff at the distal anastomosis. Journal of Vascular Surgery. 1997;26(4):543–550. doi: 10.1016/S0741-5214(97)70051-X. PubMed DOI

Griffiths G. D., Nagy J., Black D., Stonebridge P. A. Randomized clinical trial of distal anastomotic interposition vein cuff in infrainguinal polytetrafluoroethylene bypass grafting. British Journal of Surgery. 2004;91(5):560–562. doi: 10.1002/bjs.4501. PubMed DOI

Ulus A. T., Ljungman C., Almgren B., Hellberg A., Bergqvist D., Karacagil S. The influence of distal runoff on patency of infrainguinal vein bypass grafts. Vascular Surgery. 2001;35(1):31–35. doi: 10.1177/153857440103500106. PubMed DOI

Dorigo W., Pulli R., Castelli P., et al. A multicenter comparison between autologous saphenous vein and heparin-bonded expanded polytetrafluoroethylene (ePTFE) graft in the treatment of critical limb ischemia in diabetics. Journal of Vascular Surgery. 2011;54(5):1332–1338. doi: 10.1016/j.jvs.2011.05.046. PubMed DOI

Loh S. A., Howell B. S., Rockman C. B., et al. Mid- and long-term results of the treatment of infrainguinal arterial occlusive disease with precuffed expanded polytetrafluoroethylene grafts compared with vein grafts. Annals of Vascular Surgery. 2013;27(2):208–217. doi: 10.1016/j.avsg.2012.04.018. PubMed DOI

Kreienberg P. B., Darling R. C., III, Chang B. B., Paty P. S. K., Lloyd W. E., Shah D. M. Adjunctive techniques to improve patency of distal prosthetic bypass grafts: polytetrafluoroethylene with remote arteriovenous fistulae versus vein cuffs. Journal of Vascular Surgery. 2000;31(4):696–701. doi: 10.1067/mva.2000.104597. PubMed DOI

Donker J. M. W., Ho G. H., Te Slaa A., et al. Midterm results of autologous saphenous vein and ePTFE pre-cuffed bypass surgery in peripheral arterial occlusive disease. Vascular and Endovascular Surgery. 2011;45(7):598–603. doi: 10.1177/1538574411414923. PubMed DOI

Giannoukas A. D. Lower limb revascularization with infragenicular bypass using PTFE graft and the distal vein patch technique: does it confer any advantage over the distal vein cuff techniques? European Journal of Vascular and Endovascular Surgery. 2012;44(2):183–184. doi: 10.1016/j.ejvs.2012.05.007. PubMed DOI

Naoum J. J., Arbid E. J. Bypass surgery in limb salvage: polytetrafluoroethylene prosthetic bypass. Methodist DeBakey Cardiovascular Journal. 2012;8(4):43–46. PubMed PMC