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Lloyd D Fisher - One of the best experts on this subject based on the ideXlab platform.
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Femoropopliteal Bypass with externally supported knitted dacron grafts a follow up of 200 grafts for one to twelve years
Journal of Vascular Surgery, 1994Co-Authors: Sherif Elmassry, Ehab Saad, Michael Zammit, Lester R Sauvage, James C. Smith, Christopher C. Davis, Edward A. Rittenhouse, Lloyd D FisherAbstract:Abstract Purpose: This article reports our experience with externally supported, preclotted knitted Dacron grafts in Femoropopliteal Bypass. Methods: This is a retrospective analysis of a consecutive series of 154 patients who received 200 grafts (175 above knee and 25 below knee). Follow-up extended to 12 years (mean 59 ½ months). Results: Primary patency rates for the entire series were 75%, 70%, and 47% at 3, 5, and 10 years, respectively. Above-knee grafts had 76%, 71%, and 50% rates and 3, 5, and 10 years, respectively. Below-knee grafts had 65% and 57% at 3 and 5 years, respectively. Limb-salvage rates were 87%, 79%, and 73% at 3, 5, and 10 years, respectively, for the 57 limbs operated on because of critical ischemia. The most significant predictor of graft failure was poor runoff as determined by preoperative arteriography. The effect of poor runoff was most pronounced in the first 3 months. Conclusion: Externally supported, preclotted knitted Dacron grafts provide encouraging primary patency rates for above-knee Femoropopliteal Bypass. Poor leg vessel runoff is a major determinant of early graft failure. (J VASC SURG 1994;19:487-94.)
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platelet aggregometry can accurately predict failure of externally supported knitted dacron Femoropopliteal Bypass grafts
Journal of Vascular Surgery, 1993Co-Authors: Ehab Saad, Svetlana Kaplan, Sherif Elmassry, Alexander Kaplan, Karen F Marcoe, Michael Zammit, Lloyd D Fisher, Lester R SauvageAbstract:Abstract Purpose: Our purpose was to evaluate whether a method for quantification of platelet aggregability will predict failure of knitted Dacron Femoropopliteal Bypass grafts. Methods: A numerically derived platelet aggregation (PA) score, based on the aggregation pattern and platelet count, was determined in the 40 patients available for platelet analysis who underwent 53 Femoropopliteal Bypass grafts with preclotted, 6 mm, externally supported knitted Dacron grafts from 1981 to 1991 (mean follow-up 50 months). The preoperative score was found to remain stable after surgery, enabling the use of postoperative values when preoperative values were not available. The PA score was available in 19 patients (23 grafts) before surgery and 23 patients (30 grafts) after surgery. The following factors were analyzed for predicting graft failure by the Cox proportional hazards regression model: PA score, age, gender, history of smoking, coronary artery disease, hypertension, hyperlipidemia, cerebrovascular disease, diabetes, claudication versus limb salvage, site of the distal anastomosis, previous ipsilateral Bypass, and state of the runoff as determined by preoperative angiography. Results: Of the studied risk factors, the value of the PA score was the most significant predictor of graft closure ( p Conclusions: These data suggest that the PA score is a potential risk factor for failure of Femoropopliteal Bypass with externally supported knitted Dacron grafts. (J V ASC S URG 1993;18:587-95.)
Lester R Sauvage - One of the best experts on this subject based on the ideXlab platform.
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Femoropopliteal Bypass with externally supported knitted dacron grafts a follow up of 200 grafts for one to twelve years
Journal of Vascular Surgery, 1994Co-Authors: Sherif Elmassry, Ehab Saad, Michael Zammit, Lester R Sauvage, James C. Smith, Christopher C. Davis, Edward A. Rittenhouse, Lloyd D FisherAbstract:Abstract Purpose: This article reports our experience with externally supported, preclotted knitted Dacron grafts in Femoropopliteal Bypass. Methods: This is a retrospective analysis of a consecutive series of 154 patients who received 200 grafts (175 above knee and 25 below knee). Follow-up extended to 12 years (mean 59 ½ months). Results: Primary patency rates for the entire series were 75%, 70%, and 47% at 3, 5, and 10 years, respectively. Above-knee grafts had 76%, 71%, and 50% rates and 3, 5, and 10 years, respectively. Below-knee grafts had 65% and 57% at 3 and 5 years, respectively. Limb-salvage rates were 87%, 79%, and 73% at 3, 5, and 10 years, respectively, for the 57 limbs operated on because of critical ischemia. The most significant predictor of graft failure was poor runoff as determined by preoperative arteriography. The effect of poor runoff was most pronounced in the first 3 months. Conclusion: Externally supported, preclotted knitted Dacron grafts provide encouraging primary patency rates for above-knee Femoropopliteal Bypass. Poor leg vessel runoff is a major determinant of early graft failure. (J VASC SURG 1994;19:487-94.)
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platelet aggregometry can accurately predict failure of externally supported knitted dacron Femoropopliteal Bypass grafts
Journal of Vascular Surgery, 1993Co-Authors: Ehab Saad, Svetlana Kaplan, Sherif Elmassry, Alexander Kaplan, Karen F Marcoe, Michael Zammit, Lloyd D Fisher, Lester R SauvageAbstract:Abstract Purpose: Our purpose was to evaluate whether a method for quantification of platelet aggregability will predict failure of knitted Dacron Femoropopliteal Bypass grafts. Methods: A numerically derived platelet aggregation (PA) score, based on the aggregation pattern and platelet count, was determined in the 40 patients available for platelet analysis who underwent 53 Femoropopliteal Bypass grafts with preclotted, 6 mm, externally supported knitted Dacron grafts from 1981 to 1991 (mean follow-up 50 months). The preoperative score was found to remain stable after surgery, enabling the use of postoperative values when preoperative values were not available. The PA score was available in 19 patients (23 grafts) before surgery and 23 patients (30 grafts) after surgery. The following factors were analyzed for predicting graft failure by the Cox proportional hazards regression model: PA score, age, gender, history of smoking, coronary artery disease, hypertension, hyperlipidemia, cerebrovascular disease, diabetes, claudication versus limb salvage, site of the distal anastomosis, previous ipsilateral Bypass, and state of the runoff as determined by preoperative angiography. Results: Of the studied risk factors, the value of the PA score was the most significant predictor of graft closure ( p Conclusions: These data suggest that the PA score is a potential risk factor for failure of Femoropopliteal Bypass with externally supported knitted Dacron grafts. (J V ASC S URG 1993;18:587-95.)
Sherif Elmassry - One of the best experts on this subject based on the ideXlab platform.
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Femoropopliteal Bypass with externally supported knitted dacron grafts a follow up of 200 grafts for one to twelve years
Journal of Vascular Surgery, 1994Co-Authors: Sherif Elmassry, Ehab Saad, Michael Zammit, Lester R Sauvage, James C. Smith, Christopher C. Davis, Edward A. Rittenhouse, Lloyd D FisherAbstract:Abstract Purpose: This article reports our experience with externally supported, preclotted knitted Dacron grafts in Femoropopliteal Bypass. Methods: This is a retrospective analysis of a consecutive series of 154 patients who received 200 grafts (175 above knee and 25 below knee). Follow-up extended to 12 years (mean 59 ½ months). Results: Primary patency rates for the entire series were 75%, 70%, and 47% at 3, 5, and 10 years, respectively. Above-knee grafts had 76%, 71%, and 50% rates and 3, 5, and 10 years, respectively. Below-knee grafts had 65% and 57% at 3 and 5 years, respectively. Limb-salvage rates were 87%, 79%, and 73% at 3, 5, and 10 years, respectively, for the 57 limbs operated on because of critical ischemia. The most significant predictor of graft failure was poor runoff as determined by preoperative arteriography. The effect of poor runoff was most pronounced in the first 3 months. Conclusion: Externally supported, preclotted knitted Dacron grafts provide encouraging primary patency rates for above-knee Femoropopliteal Bypass. Poor leg vessel runoff is a major determinant of early graft failure. (J VASC SURG 1994;19:487-94.)
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platelet aggregometry can accurately predict failure of externally supported knitted dacron Femoropopliteal Bypass grafts
Journal of Vascular Surgery, 1993Co-Authors: Ehab Saad, Svetlana Kaplan, Sherif Elmassry, Alexander Kaplan, Karen F Marcoe, Michael Zammit, Lloyd D Fisher, Lester R SauvageAbstract:Abstract Purpose: Our purpose was to evaluate whether a method for quantification of platelet aggregability will predict failure of knitted Dacron Femoropopliteal Bypass grafts. Methods: A numerically derived platelet aggregation (PA) score, based on the aggregation pattern and platelet count, was determined in the 40 patients available for platelet analysis who underwent 53 Femoropopliteal Bypass grafts with preclotted, 6 mm, externally supported knitted Dacron grafts from 1981 to 1991 (mean follow-up 50 months). The preoperative score was found to remain stable after surgery, enabling the use of postoperative values when preoperative values were not available. The PA score was available in 19 patients (23 grafts) before surgery and 23 patients (30 grafts) after surgery. The following factors were analyzed for predicting graft failure by the Cox proportional hazards regression model: PA score, age, gender, history of smoking, coronary artery disease, hypertension, hyperlipidemia, cerebrovascular disease, diabetes, claudication versus limb salvage, site of the distal anastomosis, previous ipsilateral Bypass, and state of the runoff as determined by preoperative angiography. Results: Of the studied risk factors, the value of the PA score was the most significant predictor of graft closure ( p Conclusions: These data suggest that the PA score is a potential risk factor for failure of Femoropopliteal Bypass with externally supported knitted Dacron grafts. (J V ASC S URG 1993;18:587-95.)
Ehab Saad - One of the best experts on this subject based on the ideXlab platform.
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Femoropopliteal Bypass with externally supported knitted dacron grafts a follow up of 200 grafts for one to twelve years
Journal of Vascular Surgery, 1994Co-Authors: Sherif Elmassry, Ehab Saad, Michael Zammit, Lester R Sauvage, James C. Smith, Christopher C. Davis, Edward A. Rittenhouse, Lloyd D FisherAbstract:Abstract Purpose: This article reports our experience with externally supported, preclotted knitted Dacron grafts in Femoropopliteal Bypass. Methods: This is a retrospective analysis of a consecutive series of 154 patients who received 200 grafts (175 above knee and 25 below knee). Follow-up extended to 12 years (mean 59 ½ months). Results: Primary patency rates for the entire series were 75%, 70%, and 47% at 3, 5, and 10 years, respectively. Above-knee grafts had 76%, 71%, and 50% rates and 3, 5, and 10 years, respectively. Below-knee grafts had 65% and 57% at 3 and 5 years, respectively. Limb-salvage rates were 87%, 79%, and 73% at 3, 5, and 10 years, respectively, for the 57 limbs operated on because of critical ischemia. The most significant predictor of graft failure was poor runoff as determined by preoperative arteriography. The effect of poor runoff was most pronounced in the first 3 months. Conclusion: Externally supported, preclotted knitted Dacron grafts provide encouraging primary patency rates for above-knee Femoropopliteal Bypass. Poor leg vessel runoff is a major determinant of early graft failure. (J VASC SURG 1994;19:487-94.)
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platelet aggregometry can accurately predict failure of externally supported knitted dacron Femoropopliteal Bypass grafts
Journal of Vascular Surgery, 1993Co-Authors: Ehab Saad, Svetlana Kaplan, Sherif Elmassry, Alexander Kaplan, Karen F Marcoe, Michael Zammit, Lloyd D Fisher, Lester R SauvageAbstract:Abstract Purpose: Our purpose was to evaluate whether a method for quantification of platelet aggregability will predict failure of knitted Dacron Femoropopliteal Bypass grafts. Methods: A numerically derived platelet aggregation (PA) score, based on the aggregation pattern and platelet count, was determined in the 40 patients available for platelet analysis who underwent 53 Femoropopliteal Bypass grafts with preclotted, 6 mm, externally supported knitted Dacron grafts from 1981 to 1991 (mean follow-up 50 months). The preoperative score was found to remain stable after surgery, enabling the use of postoperative values when preoperative values were not available. The PA score was available in 19 patients (23 grafts) before surgery and 23 patients (30 grafts) after surgery. The following factors were analyzed for predicting graft failure by the Cox proportional hazards regression model: PA score, age, gender, history of smoking, coronary artery disease, hypertension, hyperlipidemia, cerebrovascular disease, diabetes, claudication versus limb salvage, site of the distal anastomosis, previous ipsilateral Bypass, and state of the runoff as determined by preoperative angiography. Results: Of the studied risk factors, the value of the PA score was the most significant predictor of graft closure ( p Conclusions: These data suggest that the PA score is a potential risk factor for failure of Femoropopliteal Bypass with externally supported knitted Dacron grafts. (J V ASC S URG 1993;18:587-95.)
Mark R Jackson - One of the best experts on this subject based on the ideXlab platform.
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the effect of anticoagulation therapy and graft selection on the ischemic consequences of Femoropopliteal Bypass graft occlusion results from a multicenter randomized clinical trial
Journal of Vascular Surgery, 2002Co-Authors: Mark R Jackson, Willard C Johnson, William O Williford, James R Valentine, Patrick G ClagettAbstract:Abstract Objective: A recent retrospective study showed that the ischemic consequences of Femoropopliteal Bypass graft occlusion were more severe with polytetrafluoroethylene (PTFE) than with vein. This study examines this conclusion and whether oral anticoagulation therapy reduces the degree of ischemia after occlusion of PTFE and vein Femoropopliteal Bypass grafts. Methods: Four hundred two patients who underwent Femoropopliteal Bypass grafting (233 PTFE and 169 vein) were randomized to a postoperative regimen of either warfarin (international normalized ratio, 1.4 to 2.8) and aspirin (WASA; 325 mg daily) therapy or aspirin alone (ASA) therapy. The grade of acute ischemia at the time of graft occlusion was assessed with the Society of Vascular Surgery recommended reporting standards (I, viable; II, threatened). Early graft occlusions ( Results: There were 100 graft occlusions (67 PTFE and 33 vein) during a mean follow-up period of 36 months (PTFE) and 39 months (vein). Forty-eight patients were randomized to WASA therapy, and 52 were randomized to ASA therapy. The patients were well matched for age, atherosclerotic risk factors, operative indication, and preoperative ankle-brachial index. Overall, a greater percentage of the PTFE occlusions caused grade II ischemia than did the vein graft occlusions (48% versus 18%; P =.005). The ankle-brachial index at the time of graft occlusion was significantly lower in the PTFE grafts than in the vein grafts (0.28 versus 0.45; P =.001). The patients with PTFE who were undergoing WASA therapy at the time of graft occlusion had less grade II ischemia than did those patients who were undergoing ASA therapy (28% versus 55%; P =.057). However, the incidence rate of severe ischemia after graft occlusion remained greater with PTFE grafts and WASA therapy as compared with all the vein grafts (28% versus 18%). The vein graft occlusions had the same incidence rate of grade II ischemia with WASA therapy as with ASA therapy (20% versus 17%; P = 1.0). Conclusion: The ischemic consequences of Femoropopliteal Bypass graft occlusion are worse with PTFE than with vein. Treatment with WASA therapy lessens the severity of acute ischemia after the occlusion of PTFE graft as compared with ASA therapy but not to the degree seen with vein graft occlusion. Occlusion of Femoropopliteal vein grafts is seldom accompanied by severe ischemia and is not improved with WASA therapy. (J Vasc Surg 2002;35:292-8.)
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the consequences of a failed Femoropopliteal Bypass grafting comparison of saphenous vein and ptfe grafts
Journal of Vascular Surgery, 2000Co-Authors: Mark R Jackson, Todd P Belott, Timothy Dickason, William J Kaiser, Gregory J ModrallAbstract:OBJECTIVES: Although there are numerous reports comparing saphenous vein (SV) and polytetrafluoroethylene (PTFE) with respect to the patency rates for Femoropopliteal Bypass grafts, the clinical consequences of failed grafts are not as well described. This study compares the outcomes of failed SV and PTFE grafts with a specific emphasis on the degree of acute limb ischemia caused by graft occlusion. METHODS: Over a 6-year period, 718 infrainguinal revascularization procedures were performed, of which 189 were Femoropopliteal Bypass grafts (SV, 108; PTFE, 81). Society for Vascular Surgery/International Society for Cardiovascular Surgery (SVS/ISCVS) standardized runoff scores were calculated from preoperative arteriograms. Clinical categories of acute limb ischemia resulting from graft occlusion were graded according to SVS/ISCVS standards (I, viable; II, threatened; III, irreversible). Primary graft patency and limb salvage rates at 48 months were calculated according to the Kaplan-Meier method. RESULTS: Patients were well matched for age, sex, and comorbidities. Chronic critical ischemia was the operative indication in most cases (SV, 82%; PTFE, 80%; P =.85). Runoff scores and preoperative ankle-brachial index measurements were similar for the two groups (SV, 6.0 +/- 2.5 [SD] and 0.51 +/- 0.29; PTFE, 5.3 +/- 2.8 and 0.45 +/- 0.20; P =.06 and P =.12). The distal anastomosis was made below the knee in 60% of SV grafts and 16% of PTFE grafts (P <.001). Grade II ischemia was more likely to occur after occlusion of PTFE grafts (78%) than after occlusion of SV grafts (21%; P =.001). Emergency revascularization after graft occlusion was required for 28% of PTFE failures but only 3% of SV graft failures (P <.001). Primary graft patency at 48 months was 58% for SV grafts and 32% for PTFE grafts (P =.008). Limb salvage was achieved in 81% of SV grafts but only 56% of PTFE grafts (P =.019). CONCLUSIONS: Patients undergoing Femoropopliteal Bypass grafting with PTFE are at greater risk of ischemic complications from graft occlusion and more frequently require emergency limb revascularization as a result of graft occlusion than patients receiving SV grafts. Graft patency and limb salvage are superior with SV in comparison with PTFE in patients undergoing Femoropopliteal Bypass grafting.
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The consequences of a failed Femoropopliteal Bypass grafting: Comparison of saphenous vein and PTFE grafts
Journal of Vascular Surgery, 2000Co-Authors: Mark R Jackson, Todd P Belott, Timothy Dickason, William J Kaiser, J. Gregory Modrall, R. James Valentine, G.patrick ClagettAbstract:OBJECTIVES: Although there are numerous reports comparing saphenous vein (SV) and polytetrafluoroethylene (PTFE) with respect to the patency rates for Femoropopliteal Bypass grafts, the clinical consequences of failed grafts are not as well described. This study compares the outcomes of failed SV and PTFE grafts with a specific emphasis on the degree of acute limb ischemia caused by graft occlusion. METHODS: Over a 6-year period, 718 infrainguinal revascularization procedures were performed, of which 189 were Femoropopliteal Bypass grafts (SV, 108; PTFE, 81). Society for Vascular Surgery/International Society for Cardiovascular Surgery (SVS/ISCVS) standardized runoff scores were calculated from preoperative arteriograms. Clinical categories of acute limb ischemia resulting from graft occlusion were graded according to SVS/ISCVS standards (I, viable; II, threatened; III, irreversible). Primary graft patency and limb salvage rates at 48 months were calculated according to the Kaplan-Meier method. RESULTS: Patients were well matched for age, sex, and comorbidities. Chronic critical ischemia was the operative indication in most cases (SV, 82%; PTFE, 80%; P =.85). Runoff scores and preoperative ankle-brachial index measurements were similar for the two groups (SV, 6.0 +/- 2.5 [SD] and 0.51 +/- 0.29; PTFE, 5.3 +/- 2.8 and 0.45 +/- 0.20; P =.06 and P =.12). The distal anastomosis was made below the knee in 60% of SV grafts and 16% of PTFE grafts (P
