Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions

Frank J. Veith, Sushil K. Gupta, Enrico Ascer, Sheila White-Flores, Russell H. Samson, Larry A. Scher, Jonathan B. Towne, Victor M. Bernhard, Patricia Bonier, William R. Flinn, Patricia Astelford, James S T Yao, John J. Bergan

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Abstract

Autologous saphenous vein (ASV) and polytetrafluoroethylene (PTFE) grafts were compared in 845 infrainguinal bypass operations, 485 to the popliteal artery and 360 to infrapopliteal arteries. Life-table primary patency rates for randomized PTFE grafts to the popliteal artery paralleled those for randomized ASV grafts to the same level for 2 years and then became significantly different (4-year patency rate of 68% ± 8% [SE] for ASV vs. 47% ± 9% for PTFE, p < 0.025). Four-year patency differences for randomized above-knee grafts were not statistically significant (61% ± 12% for ASV vs. 38% ± 13% for PTFE, p > 0.25) but were for randomized below-knee grafts (76% ± 9% for ASV vs. 54% ± 11% for PTFE, p < 0.05). Four-year limb salvage rates after bypasses to the popliteal artery to control critical ischemia did not differ for the two types of randomized grafts (75% ± 10% for ASV vs. 70% ± 10% for PTFE, p > 0.25). Although primary patency rates for randomized and obligatory PTFE grafts to the popliteal artery were significantly different (p < 0.025), 4-year limb salvage rates were not (70% ± 10% vs. 68% ± 20%, p > 0.25). Primary patency rates at 4 years for infrapopliteal bypasses with randomized ASV were significantly better than those with randomized PTFE (49% ± 10% vs. 12% ± 7%, p < 0.001). Limb salvage rates at 3 1 2 years for infrapopliteal bypasses with both randomized grafts (57% ± 10% for ASV and 61% ± 10% for PTFE) were better than those for obligatory infrapopliteal PTFE grafts (38% ± 11%, p < 0.01). These results fail to support the routine preferential use of PTFE grafts for either femoropopliteal or more distal bypasses. However, this graft may be used preferentially in selected poor-risk patients for femoropopliteal bypasses, particularly those that do not cross the knee. Although every effort should be made to use ASV for infrapopliteal bypasses, a PTFE distal bypass is a better option than a primary major amputation.

Original languageEnglish (US)
Pages (from-to)104-114
Number of pages11
JournalJournal of Vascular Surgery
Volume3
Issue number1
DOIs
StatePublished - 1986

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Saphenous Vein
Polytetrafluoroethylene
Transplants
Popliteal Artery
Knee
Limb Salvage
Life Tables
Amputation
Arteries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions. / Veith, Frank J.; Gupta, Sushil K.; Ascer, Enrico; White-Flores, Sheila; Samson, Russell H.; Scher, Larry A.; Towne, Jonathan B.; Bernhard, Victor M.; Bonier, Patricia; Flinn, William R.; Astelford, Patricia; Yao, James S T; Bergan, John J.

In: Journal of Vascular Surgery, Vol. 3, No. 1, 1986, p. 104-114.

Research output: Contribution to journalArticle

Veith, FJ, Gupta, SK, Ascer, E, White-Flores, S, Samson, RH, Scher, LA, Towne, JB, Bernhard, VM, Bonier, P, Flinn, WR, Astelford, P, Yao, JST & Bergan, JJ 1986, 'Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions', Journal of Vascular Surgery, vol. 3, no. 1, pp. 104-114. https://doi.org/10.1016/0741-5214(86)90073-X
Veith, Frank J. ; Gupta, Sushil K. ; Ascer, Enrico ; White-Flores, Sheila ; Samson, Russell H. ; Scher, Larry A. ; Towne, Jonathan B. ; Bernhard, Victor M. ; Bonier, Patricia ; Flinn, William R. ; Astelford, Patricia ; Yao, James S T ; Bergan, John J. / Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions. In: Journal of Vascular Surgery. 1986 ; Vol. 3, No. 1. pp. 104-114.
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abstract = "Autologous saphenous vein (ASV) and polytetrafluoroethylene (PTFE) grafts were compared in 845 infrainguinal bypass operations, 485 to the popliteal artery and 360 to infrapopliteal arteries. Life-table primary patency rates for randomized PTFE grafts to the popliteal artery paralleled those for randomized ASV grafts to the same level for 2 years and then became significantly different (4-year patency rate of 68{\%} ± 8{\%} [SE] for ASV vs. 47{\%} ± 9{\%} for PTFE, p < 0.025). Four-year patency differences for randomized above-knee grafts were not statistically significant (61{\%} ± 12{\%} for ASV vs. 38{\%} ± 13{\%} for PTFE, p > 0.25) but were for randomized below-knee grafts (76{\%} ± 9{\%} for ASV vs. 54{\%} ± 11{\%} for PTFE, p < 0.05). Four-year limb salvage rates after bypasses to the popliteal artery to control critical ischemia did not differ for the two types of randomized grafts (75{\%} ± 10{\%} for ASV vs. 70{\%} ± 10{\%} for PTFE, p > 0.25). Although primary patency rates for randomized and obligatory PTFE grafts to the popliteal artery were significantly different (p < 0.025), 4-year limb salvage rates were not (70{\%} ± 10{\%} vs. 68{\%} ± 20{\%}, p > 0.25). Primary patency rates at 4 years for infrapopliteal bypasses with randomized ASV were significantly better than those with randomized PTFE (49{\%} ± 10{\%} vs. 12{\%} ± 7{\%}, p < 0.001). Limb salvage rates at 3 1 2 years for infrapopliteal bypasses with both randomized grafts (57{\%} ± 10{\%} for ASV and 61{\%} ± 10{\%} for PTFE) were better than those for obligatory infrapopliteal PTFE grafts (38{\%} ± 11{\%}, p < 0.01). These results fail to support the routine preferential use of PTFE grafts for either femoropopliteal or more distal bypasses. However, this graft may be used preferentially in selected poor-risk patients for femoropopliteal bypasses, particularly those that do not cross the knee. Although every effort should be made to use ASV for infrapopliteal bypasses, a PTFE distal bypass is a better option than a primary major amputation.",
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T1 - Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions

AU - Veith, Frank J.

AU - Gupta, Sushil K.

AU - Ascer, Enrico

AU - White-Flores, Sheila

AU - Samson, Russell H.

AU - Scher, Larry A.

AU - Towne, Jonathan B.

AU - Bernhard, Victor M.

AU - Bonier, Patricia

AU - Flinn, William R.

AU - Astelford, Patricia

AU - Yao, James S T

AU - Bergan, John J.

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N2 - Autologous saphenous vein (ASV) and polytetrafluoroethylene (PTFE) grafts were compared in 845 infrainguinal bypass operations, 485 to the popliteal artery and 360 to infrapopliteal arteries. Life-table primary patency rates for randomized PTFE grafts to the popliteal artery paralleled those for randomized ASV grafts to the same level for 2 years and then became significantly different (4-year patency rate of 68% ± 8% [SE] for ASV vs. 47% ± 9% for PTFE, p < 0.025). Four-year patency differences for randomized above-knee grafts were not statistically significant (61% ± 12% for ASV vs. 38% ± 13% for PTFE, p > 0.25) but were for randomized below-knee grafts (76% ± 9% for ASV vs. 54% ± 11% for PTFE, p < 0.05). Four-year limb salvage rates after bypasses to the popliteal artery to control critical ischemia did not differ for the two types of randomized grafts (75% ± 10% for ASV vs. 70% ± 10% for PTFE, p > 0.25). Although primary patency rates for randomized and obligatory PTFE grafts to the popliteal artery were significantly different (p < 0.025), 4-year limb salvage rates were not (70% ± 10% vs. 68% ± 20%, p > 0.25). Primary patency rates at 4 years for infrapopliteal bypasses with randomized ASV were significantly better than those with randomized PTFE (49% ± 10% vs. 12% ± 7%, p < 0.001). Limb salvage rates at 3 1 2 years for infrapopliteal bypasses with both randomized grafts (57% ± 10% for ASV and 61% ± 10% for PTFE) were better than those for obligatory infrapopliteal PTFE grafts (38% ± 11%, p < 0.01). These results fail to support the routine preferential use of PTFE grafts for either femoropopliteal or more distal bypasses. However, this graft may be used preferentially in selected poor-risk patients for femoropopliteal bypasses, particularly those that do not cross the knee. Although every effort should be made to use ASV for infrapopliteal bypasses, a PTFE distal bypass is a better option than a primary major amputation.

AB - Autologous saphenous vein (ASV) and polytetrafluoroethylene (PTFE) grafts were compared in 845 infrainguinal bypass operations, 485 to the popliteal artery and 360 to infrapopliteal arteries. Life-table primary patency rates for randomized PTFE grafts to the popliteal artery paralleled those for randomized ASV grafts to the same level for 2 years and then became significantly different (4-year patency rate of 68% ± 8% [SE] for ASV vs. 47% ± 9% for PTFE, p < 0.025). Four-year patency differences for randomized above-knee grafts were not statistically significant (61% ± 12% for ASV vs. 38% ± 13% for PTFE, p > 0.25) but were for randomized below-knee grafts (76% ± 9% for ASV vs. 54% ± 11% for PTFE, p < 0.05). Four-year limb salvage rates after bypasses to the popliteal artery to control critical ischemia did not differ for the two types of randomized grafts (75% ± 10% for ASV vs. 70% ± 10% for PTFE, p > 0.25). Although primary patency rates for randomized and obligatory PTFE grafts to the popliteal artery were significantly different (p < 0.025), 4-year limb salvage rates were not (70% ± 10% vs. 68% ± 20%, p > 0.25). Primary patency rates at 4 years for infrapopliteal bypasses with randomized ASV were significantly better than those with randomized PTFE (49% ± 10% vs. 12% ± 7%, p < 0.001). Limb salvage rates at 3 1 2 years for infrapopliteal bypasses with both randomized grafts (57% ± 10% for ASV and 61% ± 10% for PTFE) were better than those for obligatory infrapopliteal PTFE grafts (38% ± 11%, p < 0.01). These results fail to support the routine preferential use of PTFE grafts for either femoropopliteal or more distal bypasses. However, this graft may be used preferentially in selected poor-risk patients for femoropopliteal bypasses, particularly those that do not cross the knee. Although every effort should be made to use ASV for infrapopliteal bypasses, a PTFE distal bypass is a better option than a primary major amputation.

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