Division of Vascular Surgery, George Washington University, Washington, DC 20037, USA.
J Vasc Surg. 2012 Oct;56(4):1008-14. doi: 10.1016/j.jvs.2012.03.020. Epub 2012 Jun 6.
Expanded polytetrafluoroethylene (ePTFE) bonded with heparin (HePTFE) has been reported to perform equivalent to saphenous vein graft (SVG) for below-knee bypass. This series examines outcomes for tibial artery bypass using HePTFE and SVG over a contemporaneous time period.
A retrospective analysis of prospectively collected data was conducted for 112 tibial bypasses (62 HePTFE, 50 SVG) performed from November 2006 to January 2009. Demographics for age, sex, race, diabetes mellitus, and end-stage renal disease were similar. Indications for revascularization were also similar: disabling claudication, 9%; rest pain, 25%; and tissue loss, 66%. The HePTFE group included more reoperative procedures (45% vs 26%). All HePTFE bypasses were performed using an autologous vein patch at the distal anastomosis. Postoperative graft surveillance by pulse examination, ankle-brachial index, and duplex ultrasound imaging occurred at 1, 3, 6, and 12 months. Follow-up ranged from 1 to 12 months. Kaplan-Meier and Cox regression analysis evaluated results in patients with no missing variables.
HePTFE and SVG bypasses demonstrated no significant differences in target tibial artery distribution: anterior tibial (15 vs 17), dorsalis pedis (4 vs 5), posterior tibial (22 vs 16), and peroneal (21 vs 12). Graft occlusion occurred in 19 patients (16.9%) during follow-up. Primary patency at 1 year was 75.4% for HePTFE and 86.0% for SVG. There was no significant difference in primary patency due to sex (male, 78%; female, 84%), race (white, 82%; African American, 77%), or diabetes mellitus (no diabetes mellitus, 84%; diabetes mellitus, 76%). End-stage renal disease resulted in decreased patency (57%), with an eightfold reduction (95% confidence interval, 1.8%-39.8%; P = .006). SVG patients had a lower risk of occlusion/death (95% confidence interval, 14.2%-94.5%; P > .05). Sixteen amputations were performed, with no significant difference based on conduit.
This experience indicates a trend for single-segment quality saphenous vein to remain the conduit of choice for tibial artery bypass compared with HePTFE. Factors relevant to decreased 1-year patency for the entire cohort were end-stage renal disease and nonhealing ulceration as the indication for revascularization. Although relatively short-term, these results do support HePTFE as a viable alternative conduit for patients with absent or poor quality saphenous vein who need a tibial bypass.
已报道，与带肝素的膨体聚四氟乙烯（HePTFE）结合的膨体聚四氟乙烯（ePTFE）在膝下旁路中与大隐静脉移植物（SVG）的性能相当。本系列研究了在同期内使用 HePTFE 和 SVG 进行胫骨动脉旁路的结果。
对 2006 年 11 月至 2009 年 1 月期间进行的 112 例胫骨旁路手术（62 例 HePTFE，50 例 SVG）进行前瞻性收集数据的回顾性分析。年龄、性别、种族、糖尿病和终末期肾病的人口统计学数据相似。血管重建的指征也相似：运动性跛行占 9%；静息痛占 25%；组织缺失占 66%。HePTFE 组包括更多的再次手术（45%比 26%）。所有 HePTFE 旁路均在远端吻合处以自体静脉补丁完成。术后通过脉搏检查、踝肱指数和双功超声成像在 1、3、6 和 12 个月时进行移植物监测。随访时间为 1 至 12 个月。无缺失变量的患者进行 Kaplan-Meier 和 Cox 回归分析评估结果。
HePTFE 和 SVG 旁路在目标胫骨动脉分布方面无显著差异：胫前动脉（15 比 17）、足背动脉（4 比 5）、胫后动脉（22 比 16）和腓动脉（21 比 12）。在随访期间，19 名患者（16.9%）发生移植物闭塞。HePTFE 组和 SVG 组 1 年的原发性通畅率分别为 75.4%和 86.0%。性别（男性 78%；女性 84%）、种族（白人 82%；非裔美国人 77%）或糖尿病（无糖尿病 84%；糖尿病 76%）均未导致原发性通畅率出现显著差异。终末期肾病导致通畅率下降（57%），风险降低 8 倍（95%置信区间 1.8%-39.8%；P=.006）。SVG 患者的闭塞/死亡风险较低（95%置信区间 14.2%-94.5%；P >.05）。进行了 16 例截肢术，基于移植物无明显差异。
该经验表明，与 HePTFE 相比，单一节段质量大隐静脉在胫骨动脉旁路中仍然是首选移植物。与整个队列 1 年通畅率降低相关的因素是终末期肾病和愈合性溃疡作为血管重建的指征。尽管相对短期，但这些结果确实支持 HePTFE 作为一种可行的替代移植物，适用于需要胫骨旁路且大隐静脉缺失或质量差的患者。
