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PTFE bypass to below-knee arteries: distal vein collar or not? A prospective randomised multicentre study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
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2010 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 39, no 6, 747-754 p.Article in journal (Refereed) Published
Abstract [en]

Background

Patency and limb salvage after synthetic bypass to the arteries below-knee are inferior to that which can be achieved with autologous vein. Use of a vein collar at the distal anastomosis has been suggested to improve patency and limb salvage, a problem that is analysed in this randomised clinical study.

Methods

Patients with critical limb ischaemia undergoing polytetrafluoroethylene (PTFE) bypass to below-knee arteries were randomly either assigned a vein collar or not in two groups – bypass to the popliteal artery below-knee (femoro-popliteal below-knee (FemPopBK)) and more distal bypass (femoro-distal bypass (FemDist)). Follow-up was scheduled until amputation, death or at most 5 years, whichever event occurred first.

Results

In the FemPopBK and in the FemDist groups, 115/202 and 72/150 were randomised to have a vein collar, respectively. Information was available for 345 of 352 randomised patients (98%).

At 3 years, primary patency was 26% (95% confidence interval (CI) 18–38) with a vein collar and 43 (33–58) without a vein collar for femoro-popliteal bypass and 20 (11–38), and 17 (9–33) for femoro-distal bypass, respectively. The corresponding figures for limb salvage were 64 (54–75) and 61 (50–74) for femoro-popliteal bypass, and 59 (46–76) and 44 (32–61) for femoro-distal bypass with and without a vein collar, respectively. Log-rank-test for the whole Kaplan–Meier life table curve showed no statistically significant differences with or without vein collar primary patency: p = 0.0853, p = 0.228; secondary patency: p = 0.317, p = 0.280; limb salvage: p = 0.757, p = 0.187 for FemPopBK and FemDist, respectively. The use of a vein collar did not influence patency or limb salvage.

Conclusion

This study failed to show any benefit for vein collar with PTFE bypass to a below-knee artery.

Place, publisher, year, edition, pages
2010. Vol. 39, no 6, 747-754 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-139596DOI: 10.1016/j.ejvs.2010.01.016PubMedID: 20236841OAI: oai:DiVA.org:uu-139596DiVA: diva2:381724
Available from: 2010-12-28 Created: 2010-12-28 Last updated: 2017-12-11Bibliographically approved

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Bergqvist, DavidBjörck, MartinLjungman, Krister

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