Cadaveric Vein Vs. PTFE As Last Resort Option For Distal Bypass
Andre Rafizadeh, Doctor of Medicine, Leia Kessler, Bachelors Degree, Clifford Sales, Doctor of Medicine, Cindy Sturt, Doctor of Medicine.
The Cardiovascular Care Group, Springfield, NJ, USA.
OBJECTIVES: Limb salvage in the era of endovascular interventions brings to light the importance of choosing an appropriate conduit for patients with chronic lower extremity ischemia. While primary endovascular approaches and autogenous conduit remain the procedures of choice, there are instances where these options simply are not available. Prosthetic conduits and cadaveric veins are two alternative options employed for tibial bypasses. The technical aspects are similar, but the costs of these two conduits differ markedly. We reviewed our experience with tibial bypasses using cadaveric vein and PTFE with regards to limb salvage and survival.
METHODS: All patients that underwent a tibial (or more distal) bypass using cadaveric vein or PTFE during 2017-2019 were included. Demographics, inflow and outflow vessels, conduit choice, prior interventions, and lifelong follow-up were recorded. Primary outcomes were limb salvage and patient survival.
RESULTS: 27 patients underwent distal bypass procedures with non-autogenous conduitsó14 with cadaveric vein and 13 with PTFE. All patients had prior interventions and autogenous vein was not available for the bypass procedure. The decision for conduit use was that of the operating surgeon. At one-year follow-up, five of 14 (36%) of CAD vein patients were alive with a functional limb and four of 13 (31%) PTFE patients were alive with a functional limb (p=.78, NS. SE=.13). Lifetable analysis indicates an 83% limb salvage rate at one year for the CAD vein group compared to 46% in the PTFE group. However, eight (8/14, 57%) in the CAD vein group died during the first year in contrast to one deceased (1/13, 7.7%) in the PTFE group (p=.0065, SE=.15). The average cost of the CAD vein was $10,000, while PTFE was $2725.
CONCLUSIONS: These results highlight the ongoing challenges of limb salvage surgery. Despite the retrospective nature of this review, the similarity in results at one year is apparent. However, if one can identify patients who will survive for one year, there is a suggestion that CAD vein may hold a benefit in terms of limb salvage. Unfortunately, this study is not powered enough to make that statement. We do advocate consideration of the extremely high cost of utilizing cadaveric vein as a bypass conduit in these difficult clinical situations.
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