Is Tibial/Peroneal Arterial Revascularization with Polytetrafluoroethylene (PTFE) an Effective Surgical Strategy for Critical Limb Ischemia (CLI)? A 30 Year Experience
Nicholas J. Gargiulo, III, MD FACS RVT RPVI RDMS, Greg Landis, MD FACS RVT RPVI, Frank J. Veith, MD FACs, Evan Lipsitz, MD FACS, Neal Cayne, MD FACS RVT RPVI.
Clinch Valley Health, Richlands, NY, USA.
Is Tibial/Peroneal Arterial Revascularization with Polytetrafluoroethylene (PTFE) an Effective Surgical Strategy for Critical Limb Ischemia (CLI)? A 30 Year Experience
Background: Polytetrafluoroethylene (PTFE) tibial and peroneal bypasses without adjunctive procedures have been advocated for critical limb ischemia in circumstances when autologous saphenous vein is not available.
Methods: A retrospective analysis was performed on a group of 377 patients with critical limb ischemia requiring revascularization between July 1977 and June 2011. These 377
patients underwent 411 PTFE bypasses to a tibial or peroneal artery without any adjunctive procedure. Cumulative life table primary and secondary patency and limb salvage rates were calculated for those bypasses performed between July 1977 through June 1987 (Group I). These were compared to those performed between July 1987 through June 1997 (Group II) and July 1997 through June 2011 (Group III). Ethnic background, TASC distribution, hemoglobin A1C levels, and inflammatory mediators (CRP, IL-6, and IL-10) were measured in a subset of Group III patients. Multivariate logistic regression was used to calculate intergroup differences with significance determined as P<0.02.
Results: Five- and 10-year primary patency and five- and 10-year limb salvage for Group I patients was 28.6%, 9.0%, 55.0%, and 27% respectively, for Group II patients was 27.3%, 9.9%, 50.0%, and 26%, respectively, and for Group III patients was 34.0%, 11%, 73.3%, and 33% respectively. Patency and limb salvage for Group III patients exceeded that observed in Group I and II patients which correlated with the implementation of several perioperative strategies. Group III patients manifested a statistically better outcome compared to Group I and II patients. Interestingly, Group III patients manifested a greater distribution of TASC II D atherosclerotic disease and a greater percentage of Latino patients compared to Group I and II patients, and in this subset of patients had a trend towards a statistically worse five- and 10-year primary patency and five- and 10-year limb salvage rate (P=0.12). There was no direct correlation between hemoglobin A1C level, PTFE patency or successful limb salvage rates in any of the Groups (P>0.02). There was a trend towards a statistical correlation to PTFE graft patency and inflammatory mediators (CRP, IL-6 and IL-10, P=0.17).
Conclusions: PTFE bypasses without adjunctive procedures to infrapopliteal arteries is an acceptable alternative option for those patients without autologous vein.
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