Below knee femoropopliteal bypass in severe ischaemia: results using EXS Dacron and human umbilical vein.

This paper reports our preliminary experience using EXS Dacron for infrageniculate femoropopliteal grafts in elderly patients, the majority (78%) suffering critical ischaemia. A comparison is made with human umbilical vein grafts (HUV). Ninety patients (mean age 69 years) with 92 grafts (42 EXS, 50 HUV) were followed up using ultrasound imaging to detect patency (median follow up 26 weeks (range 1-292)). Two and one year cumulative survivals were 57% and 80% for EXS Dacron and 39% and 48% for HUV respectively. Early failure of HUV grafts accounted for most but not all of the difference in survival (P = 0.0012, Wilcoxon Breslow). Graft kinking was not seen in EXS grafts and in only 2 HUV. Poor calf vessel run off was related to early graft occlusion (P = 0.01; Savage, Mantel Cox). This preliminary experience with EXS Dacron is encouraging and suggests the need for a formal randomised study.