Do Distal Arteriovenous Fistulae Improve Patency Rates of Prosthetic Infrapopliteal Arterial Bypasses? |
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Authors: | Jennifer R. Syrek Keith D. Calligaro Matthew J. Dougherty Carol A. Raviola Ignacio Rua Dominic A. DeLaurentis |
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Affiliation: | (1) Section of Vascular Surgery, Pennsylvania Hospital/University of Pennsylvania School of Medicine, Philadelphia, PA, US |
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Abstract: | p > 0.05). There were statistically significant differences in the site of distal anastomosis and quality of arterial run-off based on the Society for Vascular Surgery Ad Hoc Committee on Reporting Standards criteria (p < 0.05). All patients were placed on heparin 500 units/hour postoperatively, maintained on life-long Coumadin and followed every 3 months with duplex ultrasonography to assess graft patency. Aggressive intervention was carried out for failing grafts suspected by duplex scanning. The hospital mortality rate was 2.3% (1/43; 1 PTFE-AVF). Two-year primary patency rates were significantly better for PTFE-AVF grafts than for PTFE-ONLY grafts (23% versus 5%) (p= 0.04). Although statistical significance was not reached, there was a suggestion of higher assisted primary (34% versus 15%) (p > 0.05) and secondary (61% versus 48%) (p > 0.05) patency rates in the PTFE-AVF group versus the PTFE-ONLY group, although limb salvage rates were similar (74% versus 71%) (p > 0.05). Two AVFs required ligation because of steal resulting in diminished distal perfusion. These results support the use of adjunctive distal AVFs to improve overall two-year patency rates of prosthetic infrapopliteal arterial bypasses. |
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