The choice of material for above-knee femoropopliteal bypass. A 20-year experience
G. A. Berlakovich, F. Herbst, M. Mittlbock and G. Kretschmer
First Department of Surgery, University of Vienna, Austria.
OBJECTIVE: The choice of material for above-knee femoropopliteal bypass
grafting is a matter of continuing controversy for various reasons. The
most important argument in favor of alloplastic grafts is to preserve the
autologous saphenous vein for a below-knee bypass, which might become
indicated at a later date. DESIGN: A consecutive series of above-knee
reconstructions were analyzed with regard to long-term behavior. Early
graft occlusions were not included, and the median follow-up was 83 months.
SETTING: A university hospital with a particular interest in vascular
surgery. PATIENTS AND METHODS: Four hundred forty-two patients received
either autologous saphenous vein (n = 310) or alloplastic graft (n = 132)
material, and were analyzed in a univariate (Kaplan-Meier) and multivariate
(Cox) manner. MAIN OUTCOME MEASURES: Analysis as to whether alloplastic
graft material provides equal or less favorable results as compared with
autologous saphenous vein material, in terms of primary and secondary
patency, secondary below-knee bypass grafting, limb salvage, and survival.
RESULTS: Although univariate analysis demonstrated a significantly better
primary patency rate for autologous saphenous vein material, multivariate
analysis did not show any effect of the material in terms of patency, limb
salvage, and survival. The frequency of secondary below-knee repair was 7%
(31 patients); 56% were performed in the first 2 years postoperatively.
This amounted to an estimated probability of 4.4% and 12.3% at 18 years,
respectively. CONCLUSION: The small probability of secondary below-knee
repair in our series does not support the policy to use alloplastic grafts
routinely for a primary above-knee bypass, to spare the saphenous vein.
Therefore, patients should be offered the best material for the first
operation even at the above-knee level.
