Long-term outcomes of below-the-knee bypass surgery using heparin-bonded expanded polytetrafluoroethylene grafts

Yohei Yamamoto; Hidetoshi Uchiyama; Masahiro Oonuki; Kazuki Tsukuda; Ai Kazama; Yoshiki Wada; Hiroki Uchiyama; Toru Kikuchi; Masato Nishizawa; Toshifumi Kudo

doi:10.1007/s00595-024-02898-8

Long-term outcomes of below-the-knee bypass surgery using heparin-bonded expanded polytetrafluoroethylene grafts

Surg Today. 2024 Jul 17. doi: 10.1007/s00595-024-02898-8. Online ahead of print.

Affiliations

¹ Division of Vascular Surgery, Department of Cardiovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. y-yamamoto.srg1@tmd.ac.jp.
² Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki, 300-0028, Japan.
³ Division of Vascular Surgery, Department of Cardiovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.

PMID: 39017747
DOI: 10.1007/s00595-024-02898-8

Abstract

Purpose: To report the outcomes of below-the-knee (BK) bypass surgery using heparin-bonded expanded polytetrafluoroethylene (ePTFE) grafts, performed in two centers since its launch in Japan.

Methods: We conducted a retrospective analysis of databases from two medical centers, evaluating 51 limbs in 42 consecutive patients with peripheral arterial disease (PAD), who underwent BK bypass surgery using heparin-bonded ePTFE grafts between October, 2013 and April, 2023.

Results: Thirty-three limbs (64.7%) were classified as Rutherford category 4-6 and 33 limbs (64.7%) had a history of ipsilateral revascularization. Technical success was achieved in 98% of the patients. The 30 day mortality rate was 2.4% (n = 1) and the overall 30 day complication rate was 9.5% (n = 4). The median follow-up period was 38 (interquartile range 13-67) months. Three patients required major amputation and 14 died during follow-up. Primary patency rates at 1, 3, and 5 years were 67.8%, 57.5%, and 46.5%, respectively, while secondary patency rates for these periods were 84.6%, 70.0%, and 66.0%, respectively. Overall survival rates at 1, 3, and 5 years were 90.1%, 74.5%, and 70.9%, respectively.

Conclusions: BK bypass surgery using heparin-bonded ePTFE graft is a viable and durable option for patients with PAD, who are deemed unsuitable for autologous vein bypass surgery.

Keywords: Below the knee; Heparin-bonded expanded polytetrafluoroethylene graft; Infrainguinal bypass; Peripheral arterial disease.