Factors Affecting Long-Term Results of Above-Knee Femoropopliteal Bypass: A Single-Center Contemporary Study.

INTRODUCTION

The aim of this study was to assess whether individual patients' or bypass characteristics may influence long-term results of prosthetic above-knee femoropopliteal bypasses in patients with claudication in today's endovascular era.

METHODS

Seventy-one consecutivee Expanded Polytetrafluoroethylene (e-PTFE) bypasses were considered. All patients presented a debilitating claudication. Patency of grafts was achieved by Kaplan-Meier method. The association between individual patients' or graft characteristics and primary patency (PP) or secondary patency (SP) was assessed via Cox regression models.

RESULTS

An immediate technical success was achieved in all cases. No patient was lost during follow-up (8-90 months, median = 34 months). The median PP was 48 months. Occlusion occurred in 32 bypasses (45%). Eight (25%) of these were treated conservatively. Fifty-two bypasses (73%) were still patent at the end of follow-up, and 13 (25%) of these had been submitted to one or more surgical revisions. There were 2 graft infections. Of 17 (25%) patients with occluded graft at the end of follow-up, 2 (2.8%) had significant aggravation followed by limb loss. The PP was directly influenced by undetected minor distal anastomosis technical defects (hazard ratio [HR] = 5.89, P value = .000002), popliteal artery size (HR = 0.62, P value = 0.007), and distal anastomosis angle ≥40° (HR = 5.55, P value = .003). The SP was associated strictly to technical defects (HR = 11.08, P value = .000007). Multivariable analyses confirmed the influence of technical defects (HR = 6.42, P value = .000003) and anastomosis angle (HR = 1.05, P value = .009) on PP and that of technical defects on SP (HR = 10.84, P value = .00003). A significantly shorter SP was also observed after a previous failed endovascular treatment on the superficial femoral artery (HR = 3.73, P value = .02).

CONCLUSION

An adequate arterial size, an ideal anastomotic angle, and the absence of minor, technical defects have a major role in prosthetic above-knee femoropopliteal bypass long-term outcome. A previous, failed endovascular procedure on the superficial femoral artery could markedly alter the natural history of patients with claudication because this approach seems to have a detrimental effect on long-term outcome of grafts needing surgical revisions.