The role of antithrombotic therapy on the patency of peripheral bypasses.

Peripheral bypass surgery is a well-established treatment for symptomatic atherosclerotic disease of the legs. To improve the long-term patency antithrombotic drugs and other adjuvant treatment are applied. In this review we summarize the results of randomized studies concerning antithrombotic treatment for prophylaxis after peripheral bypass surgery. Heparin is used routinely intra- and perioperatively without strong data, and according to few data low molecular weight heparin may be superior in this situation. Aspirin had positive effects in placebo-controlled studies after infrainguinal PTFE-bypasses, furthermore it is recommended due to its general cardiovascular risk reduction. Ticlopidine improved long-term patency in one randomized study after venous bypass surgery. Otherwise there are some data that long-term oral anticoagulation may be preferable in patients after venous bypass surgery.