Kirkwood Melissa L, Wang Grace J, Jackson Benjamin M, Golden Michael A, Fairman Ronald M, Woo Edward Y
Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
Vasc Endovascular Surg. 2011 May;45(4):329-34. doi: 10.1177/1538574411401757. Epub 2011 Mar 28.
To assess the patency of the PROPATEN Graft in lower extremity bypasses.
We retrospectively reviewed all lower extremity bypasses with the PROPATEN Graft from 2007-2009 at a single institution. There were 68 implants--56% male; mean age 69. Comorbidities included hypertension (HTN; 81%), hyperlipidemia (72%), coronary artery disease (CAD; 74%), and smoking (59%). Most patients were Rutherford category 4 or higher. A total of 34% of patients had only 1 runoff vessel; 10% of patients required a complex concomitant procedure with sequential extremity revascularization. Statistics were via Kaplan Meier.
Mean follow-up was 10.4 ± 8.0 months (0-30). Patency was excellent in all positions. Primary patency for all patients was 94.0% and 86.0% at 30 days and 18 months, respectively. Limb salvage at 30 days was 95%, and at 18 months was 90%. No patients developed HIT. Ten patients lost graft patency. These patients had severe peripheral vascular disease (PVD), with rest pain or tissue loss, poor runoff (no runoff or single vessel runoff), compromised inflow, and restored competitive flow. Fifty percent of the failed grafts were in the infrapopliteal position. Endovascular intervention and graft thrombectomy to restore patency was attempted in 2 patients and was unsuccessful.
The GORE PROPATEN Vascular Graft demonstrates excellent patency in all arterial positions and may be the conduit of choice for all prosthetic bypasses.
评估PROPATEN移植物在下肢旁路手术中的通畅性。
我们回顾性分析了2007年至2009年在单一机构使用PROPATEN移植物进行的所有下肢旁路手术。共有68例植入手术——男性占56%；平均年龄69岁。合并症包括高血压（81%）、高脂血症（72%）、冠状动脉疾病（74%）和吸烟（59%）。大多数患者为卢瑟福分级4级或更高。共有34%的患者只有1条流出道血管；10%的患者需要进行复杂的同期手术及序贯性肢体血管重建。采用Kaplan Meier法进行统计学分析。
平均随访时间为10.4±8.0个月（0至30个月）。各部位的通畅性均良好。所有患者在30天时的初始通畅率为94.0%，在18个月时为86.0%。30天时肢体挽救率为95%，18个月时为9%。无患者发生肝素诱导的血小板减少症（HIT）。10例患者移植物通畅性丧失。这些患者患有严重的外周血管疾病（PVD），伴有静息痛或组织缺失、流出道不佳（无流出道或单条血管流出道）、流入道受损以及恢复的竞争性血流。50%的移植物失败发生在腘以下部位。2例患者尝试进行血管腔内干预和移植物血栓切除术以恢复通畅，但未成功。
GORE PROPATEN血管移植物在所有动脉部位均显示出优异的通畅性，可能是所有人工血管旁路手术的首选管道。
