[Femoro-popliteal bypass above popliteal fossa with PTFE graft: which graft diameter is better?].

The paper presents the results of 80 femoro-popliteal bypasses above popliteal fossa for patients with lower limb atherosclerotic lesions that were fulfilled with the use of polytetrafluoroethylene (PTFE) graft in the Department of Vascular Surgery, AV Vishnevsky Institute of Surgery, from February 1992 till December 2005. 50% of patients had lower limb ischemia grade IIb, 13.7% - grade III and 36.3% - grade IV. Distal circulation was good in 41.2%, satisfactory - in 48.5% and unsatisfactory - in 10.3% of patients. The technique of surgical reconstruction was conventional. In 50% of cases the diameter of PTFE grafts was 8 mm, in another 50% - 6 mm. A statistically significant difference in bypass patency was revealed between prostheses with different diameter in late postoperative period. For the 8-mm grafts the patency rate was 93%, 64% and 51% in 12, 30 and 60 months, respectively, while for the 6-mm grafts the same rate was 62%, 44% and 31%, respectively (p=0.004).

[Long-term outcomes of femoropopliteal bypass above the knee-joint fissure by means of vascular prosthesis <> in patients with atherosclerotic lesions of lower limb arteries].

Presented herein are the remote results of a total of 110 operations of femoropopliteal shunting above the knee-joint fissure, carried out using the vascular: prosthesis <> in patients diagnosed with atherosclerotic lesions of arteries of the lower limbs over the period between November 1995 and December 2005 at the Department of Vascular Surgery of the A. V. Vishnevsky Institute of Surgery of the Russian Academy of: Medical Sciences. The operative interventions were carried out according to the conventionally accepted technique. Fifty-four (49.1%) patients were operated on for grade II B ischemia, 26 (23.6%) suffered from grade III ischaemia, and 30 (27,3%) subjects were found to have grade IV ischaemia. The average age of the patients was 60.2+/- 7.4 years. The mean values of the ankle-brachial index (ABI) along the posterior greater femoral artery (PGFA) and the anterior greater femoral artery (AGFA) in patients presenting with grade II B ischaemia amounted to 0.52+/-0.21 and 0.55+/-0.15, respectively. In patients with critical ischaemia, the respective ABI values equalled 0,37+/-0,23 and 0.4+/-0.22 Studying the state of the distal bed showed that the condition of the outflow tracts was <> in 54.3% of patients, being defined as <> in 37%, and as <> in 8,7%. The total duration of the long-term follow-up period amounted to: 100 months, averaging 28.4+/-19.5 months. The main clinical factors determining the remote: patency of the vascular prostheses <> in the femoropopliteal position were as follows; the values of the outflow score, the diameter of the popliteal artery, and the ankle-brachial index after surgery. With <> outflow tracts, the patency of the transplants after 3 years amounted to 57%., after 5 years being 48%. In cases of <> outflow tracts, the patency of the vascular prostheses 3 years, after surgery amounted to 26%. In <> outflow tracts, none of the bypasses remained passable for more than 12 months (P<0.01). The dependence between the value of the lumen of the popliteal artery and the patency of the vascular prosthesis was observed to be persisting during the first 2 years following fiurnory, In patients with arterial lumen <3 mm, the patency after 6. 12 and 18 months amounted to 61%, 47% and 41%, respectively; with the popliteal artery's lumen equalling 3.5 mm and more, the patency amounted to 77%, 63%, 42% and 86%, 68% and 56%, respectively, at the above-mentioned time intervals (P<0.05). When the value of the ABI following surgery was >1, the patency of the vascular prostheses after 60 months amounted to 41%, with the ABI>1, after 50 months, the patency amounted to 17%. With the ABI<0.9, none of the shunts remained patent for more than 31 months (P<0.05). Using the pattern of prediction of the outcomes of the femoropopliteal shunting by means of the vascular prosthesis <> above the knee-joint fissure, with due regard for the condition of the distal vascular bed the value of the lumen of the popliteal artery and the value of the ABI after surgery made it possible to rather reliably predict the patency of the prosthesis in the remote terms after surgery (P<0.01).

[Femoropopliteal bypass above the knee-joint fissure by means of a vascular prosthesis made of PTFE: choosing an appropriate diameter of the prosthesis].

Presented herein are the outcomes of a total of 80 operations of femoropopliteal grafting above the knee-joint fissure, carried out using a vascular prosthesis made of polytetrafluoroethylene (PTFE) in patients diagnosed with atherosclerotic lesions of the arteries of the lower extremities over the period between February 1995 and December 2005 at the Department of Vascular Surgery of the A. V. Vishnevsky Institute of Surgery of the Russian Academy of Medical Sciences. Fifty percent of the patients were operated on for grade II B ischemia, while 13.7% of the patients suffered from grade III ischaemia of the lower limb, and 29 (36.3%) subjects were found to have grade IV ischaemia. The condition of the distal bed was considered <> in 41.2% of the patients, being defined as <> in 48.5%, and as "poor" in 10.3%. The operative intervention was carried out according to the conventionally accepted technique. 50% of the reconstructions were performed using the prosthesis 8 mm in diameter, and 50% - using that measuring 6 mm in diameter. A statistically significant impact of the diameter of the prosthesis used on the patency of the graft in the remote postoperative period was revealed: with the prosthesis 8-mm in diameter, the patency after 12, 30 and 60 months amounted to 93%, 64% and 51%, respectively, while with the transplant measuring 6 mm in diameter, these indices at the above-mentioned time intervals did not exceed 62%, 44% and 31%, respectively (P=0.004).