Die Wahl des Ersatzmaterials für den supragenualen Bypass

Summary

To investigate whether the choice of vascular substitute was decisive in terms of primary and secondary patency, secondary bypass grafting, limb salvage and survival, a clinical series of 442 consecutive cases of primary above-knee reconstructions was analyzed. Median follow-up was 83 months. Although univariate analysis (Kaplan-Meier) demonstrated significantly better primary patency for autologous saphenous vein (VSM, n = 310) than for alloplastic grafts (APM, n = 132), multivariate analysis did not show any effect attributable to the material. Considering that below-knee bypass may later become indicated, and since VSM is the material of choice and should therefore be spared, the probability of secondary below-knee reconstructions (SBKR) was determined. 31 patients (7%) underwent SBKR with 56% and 75% thereof performed in the first 2 and 4 years, respectively. This amounted to an estimated probability (Kaplan-Meier) of 4.4% and 7%, respectively, and 12.3% at 18 years. Clinical stage, patient age, and diabetes were the most important risk factors for SBKR. The small probability of SBKR in our series does not support the policy to routinely use APM for primary above-knee bypass.