Print this pageComparison Of Spliced Vein Versus A Precuffed Prosthetic Graft (DISTAFLO®) For Infra-Geniculate Bypass
Back to Annual Meeting
Back to Program
Paul B. Kreienberg, MD, R. Clement Darling, III, MD, Sean P. Roddy, MD, Manish Mehta, MD, MPH, Philip S.K. Paty, MD, Benjamin B. Chang, MD, Kathleen J. Ozsvath, MD, Yaron Sternbach, MD, Dhiraj M. Shah, MD.
Albany Medical College, Albany, NY, USA.
Objective: When single piece vein is not available in patients requiring long bypass, several options exist to manage these situations. Two of these options are either spliced vein or prosthetic grafting with a polytetrafluoroethylene graft having a pre-shaped cuff (Distaflo®). In this study we compare spliced vein bypasses versus the Distaflo graft for patients requiring infra-geniculate bypass.
Methods: Between 2002 and 2006 164 spliced vein bypasses were performed on 155 patients and during the same period 77 Distaflo grafts were placed in 72 patients. Selection of procedure depended upon available vein, patient condition and surgeon preference. All patients who underwent prosthetic graft placement received anticoagulation with warfarin sodium after surgery.
Results: Both groups were similar with respect to age, gender, and risk factors. 96% of bypasses performed in each group were for limb - threatening indications. 30- Day mortality was similar between the two groups. Other morbidities were similar between the two groups including wound complications 11.7% Distaflo vs. 11.6% spliced vein. The primary patency at 2 years was 39% for the Distaflo group and 55% for spliced vein. In the spliced vein group 37 (51%) bypasses underwent revision during the follow-up period and 7 (10%) of the Distaflo grafts were successfully revised. Secondary patency rate was 80% for the spliced vein group and 42% for the Distaflo graft. Limb salvage was 91% in the spliced vein group and 59% in the Distaflo group at 2 years. The overall survival rate was 76% in the Distaflo group and 91% in the spliced vein group.
Conclusions: In patients requiring infra-geniculate bypass several options exist. In this study we compared spliced vein to the Distaflo graft, a graft that has a pre-shaped prosthetic cuff. Both grafts seem to produce reasonable limb salvage rates. The secondary patency and limb salvage rates favor spliced vein but these bypass grafts more often need revision for maintaining long term patency. Either option remains superior to primary amputation in this patient population. Further comparison of this difficult patient population to those undergoing endovascular treatments may be warranted.
Read the Privacy Policy.