THE LONG-TERM RESULTS AND INDICATIONS FOR USE OF GORE-TEX GRAFTS IN THE FEMOROPOPLITEAL POSITION IN PATIENTS WITH ATHEROSCLEROTIC LESION OF LOWER LIMB ARTERIES

A.V. Pokrovsky, V.N. Dan, A.E. Zotikov, A.V. Chupin, A.A. Shubin, M.V. Chikharev
Department of Vascular Surgery, A.V. Vishnevsky Institute of Surgery, Russian Academy of Medical Sciences,
Moscow, Russia

Presented herein are the long-term results of femoropopliteal reconstructions above the knee joint fiasure in patients with atherosclerotic lesion of the femoropopliteal segment using Gore-Tex grafts.

The retrospective study accrued 108 patients. Of these, IIB degree lower limb ischemia (according to the A.V.Pokrovsky classification) was initially present in 64 (60.2%) and critical ischemia in 52 (40.8%) patients. Patients suffering from lower limb ischemia of varying degree did not significantly differ in the age or coexistent diseases. The mean value of the ankle/brachial index (ABI) accounted for 0.46±0.23 in patients with IIB degree ischemia and for 0.40±0.27 in patients with critical lower limb ischemia. All the patients were evaluated for the condition of the distal bed according to the scheme proposed by Rutherford et al. in 1997. The patients were distributed into three groups: patients with "good" runoff (from 1 to 4 points, n=65), patients with "satisfactory" runoff (from 5 to 7points, n=36), and those with an "unsatisfactory" condition of the distal bed (runoff point over 7, n=7).

The long-term results were assessed in 81 (75%) patients over the period as long as 105 months. The mean follow up accounted for 58,4 months. One year later the graft patency in the total patient group constituted 73.1%, after 3 years it was equal to 54.8%, and after 5 years to 49.9%. It is demonstrated that the initial runoff point exerted a significant effect on the graft patency. It is noteworthy that in patients with an initially "good" runoff point, 57.5% of the grafts were patent 5 years after operation whereas in patients with a "satisfactory" point only 35.3% turned out patent (p<0.05). Patients with an initially "unsatisfactory" runoff point developed thrombosis of all grafts over the period as long as 6 months following operation. The five-year limb salvage was observed in 77.6% of patients. It has been revealed over the 5-year period that the degree of initial limb ischemia did not produce any significant effect on the graft patency or limb salvage. The scheme for runoff assessment allows to define in a differentiated way the indications for use of Gore-Tex grafts in the femoropopliteal position. The runoff point had a significant effect on the long-term 5-year patency of the grafts.

KEY WORDS: femoropopliteal bypass grafting, Gore-Tex graft, runoff.

P. 91-97

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