Initial Experience with a New Method of External Polyester Scaffolding for Infrainguinal Vein Grafts

• Published in: European journal of vascular and endovascular surgery Vol. 38; no. 4; pp. 456 - 462
• Main Authors: Arvela, E, Kauhanen, P, Albäck, A, Lepäntalo, M, Neufang, A, Adili, F, Schmitz-Rixen, T
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2009
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm - surgery; Equipment Design; External polyester mesh support; Feasibility Studies; Female; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - surgery; Humans; Infrainguinal bypass; Intermittent Claudication - etiology; Intermittent Claudication - surgery; Ischemia - etiology; Ischemia - surgery; Kaplan-Meier Estimate; Lower Extremity - blood supply; Male; Middle Aged; Peripheral Vascular Diseases - complications; Peripheral Vascular Diseases - diagnosis; Peripheral Vascular Diseases - physiopathology; Peripheral Vascular Diseases - surgery; Phlebography; Pilot Projects; Polyesters; Popliteal Artery - surgery; Prospective Studies; Reoperation; Surgery; Surgical Mesh; Surgical Wound Infection - etiology; Surgical Wound Infection - surgery; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Patency; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - instrumentation; Vein graft; Veins - pathology; Veins - transplantation; Vein graft; External polyester mesh support; Infrainguinal bypass
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2009.05.015

Abstract Objectives This study aims to evaluate the feasibility of external polyester scaffolding in infrainguinal bypass grafting when available vein material is suboptimal due to varicosity or dilatation. Primary objectives were short-term primary patency, assisted primary patency and secondary patency. Secondary objectives were to assess the rate of graft stenoses, infections and other adverse effects related to the use of external scaffolding. Materials and methods A total of 50 consecutive patients were included in this prospective, multicentre, feasibility study from six centres. The indication for infrainguinal bypass was critical limb ischaemia (64%), severe claudication (34%) or popliteal aneurysm (2%). Indications for the use of the external scaffolding were varicosity of the vein graft, ectatic vein graft or the use of spliced vein grafts with segments of widely differing diameters. Duplex scanning of the graft was done perioperatively and at follow-up visits at 1, 3, 6 and 12 months after operation. Results Primary patency, assisted primary patency and secondary patency at 6 months were 82.3% (±SE 6.2%), 88.6% (±SE 4.8%) and 92.1% (±SE 4.4%), respectively. Six graft stenoses were detected in duplex surveillance. There were no infections related to polyester mesh. Conclusions External scaffolding of infrainguinal vein grafts may be a promising innovation. Early results from this multicentre study show that polyester mesh is safe and feasible adjunct to peripheral revascularization enabling the use of otherwise non-optimal vein grafts with acceptable short-term patency.