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A 10-year Single Institution Overview Of PTFE Bypasses For PAD
Jemin Park, MD, Jeremy D. Darling, MD, Lucas Mota, MD, Anita P. Bargaje, BS, John N. Tomeo, BS, Camila R. Guetter, MD, MPH, Isa F. van Galen, MD, Elisa Caron, MD, Lars Stangenberg, MD, PhD, Allen D. Hamdan, MD, Mark C. Wyers, MD, Marc L. Schermerhorn, MD, Patric Liang, MD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
OBJECTIVES: Studies have demonstrated the superiority of great saphenous vein conduits for lower extremity bypass. However, prosthetic graft bypasses (PGB) continue to be performed at high rates with increasing use of tibial bypasses. We examined our institution’s experience with PGB to further understand their utilization and outcomes.
METHODS: We retrospectively reviewed patients undergoing infra-inguinal PGB for peripheral arterial disease between 2014-2023. Patient comorbidities, medications, and bypass characteristics including target vessel, PGB type, diameter, and tibial vessel run-off were analyzed. Location of graft failure was determined using operative reports and review of angiogram images. Primary outcomes included primary patency, secondary patency, and re-intervention at 1-year and were analyzed with Kaplan-Meier estimates and Log-rank tests.
RESULTS: Of the 148 PGB, 54 (36%) were AK-popliteal, 50 (34%) were BK-popliteal, and 44 (30%) were tibial. 43% of the tibial bypasses were performed in the last 3 years of the study period. The overall primary and secondary patency rates were 66% and 79% at 1-year, and 54% and 62% at 3-years. The 1- and 3-year primary patency rates were 75% and 66% for AK-popliteal, 65% and 51% for BK-popliteal, and 56% and 40% for tibial bypass, p=0.07 (Figure 1). For BK-popliteal and tibial bypasses, there were no differences in primary patency between the Distaflo and externally supported ring grafts (3-year rate: 46% vs 47%, p=0.96), diameter, or number of outflow tibial vessels. Of the 67 bypasses that occluded, location of failure was identified in 61%, and the distal anastomosis was implicated in 78% of those. The 1-year re-intervention rate was 38%; the rate stratified by bypass type was: 31% (AK-popliteal), 40% (BK-popliteal), and 46% (tibial), p=0.28.
CONCLUSIONS: Patients undergoing PGB demonstrated poor primary patency rates, with a significant proportion failing within 3 years. BK-popliteal bypasses had similarly poor patency rates compared with tibial PGB, and failure rates were not associated with graft type, diameter, or number of outflow vessels. In occluded bypasses where the location of failure could be identified, PGB failure predominately occurred due to stenosis of the distal anastomosis, frequently requiring outflow reintervention. Novel therapies and innovations are warranted to address PGB failure.
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