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Comparing short and midterm infrainguinal bypass patency rates between two ePTFE prosthetic grafts: Spiral Laminar Flow and Propaten.
Carlos F. Bechara, MD MS, George Pisimisis, MD, Neal R. Barshes, MD MPH, Peter H. Lin, MD, Panagiotis Kougias, MD.
Baylor College of Medicine, Houston, TX, USA.
Objective: The ideal prosthetic graft to use for lower extremity bypass in patients with no vein conduit is yet to be available. Spiral Laminar Flow graft (SLFG) was designed to reduce turbulant flow at the distal anastomosis; hence, reducing neointimal hyperplasia to improve graft patency. We examined our data for this type of graft and compared it to Propaten (PG) which is another ePTFE graft.
Methods: Single center data was retrospectively reviewed for patients undergoing infrainguinal bypass using prosthetic grafts between January 2010 and January 2012. Kaplan-Meier analyses were performed to estimate primary and secondary patency rates for patients undergoing femoral to popliteal artery bypass (above and below the knee) as well as femoral to tibial artery bypass. The same was done for patients undergoing infrainguinal bypass using PG during the same time period.
Results: 20 infrainguinal bypasses were performed using SLFG and 39 using PG were identified. Majority of the SLFG cases (14, 70%) were femoral to popliteal bypass (above and below the knee) and 6 cases (30%) were femoral to tibial artery bypass. Similar percentages were seen in the PG group. Statistically, the 6, 12, 18 and 24-month primary and secondary patency rates for both grafts were the same regardless of the distal target artery. The primary patency for the popliteal artery (above and below knee) target group were 94%, 61 %, 61%, and 54% for the PG group, and 79%, 50%, 50% and 50% for the SLFG group, respectively. The secondary patency rates were 94%, 66%, 66%, 66% for the PG group and 86%, 57%, 57%, 57% for the SLFG group, respectively. The 6, 12, and 18 month primary patency rates for the tibial artery bypass groups were 51%, 36%, and 37% for the PG group and 50%, 33% and 17% for the SLFG group, respectively. The secondary patency rates were 54%, 34%, and 34% for the PG group and 60%, 40%, and 20% for the SLFG group, respectively.
Conclusion: The design of the SLFG to mimic physiologic flow at the distal anastomosis is an interesting concept but has not translated into clinical benefit in comparison to another ePTFE graft in our series. Further research and modifications are needed to achieve the ideal graft for infrainguinal arterial bypass.
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