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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, William O Williford, Willard C. Johnson, 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 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, William O Williford, Willard C. Johnson, 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: Todd P Belott, Timothy Dickason, Mark R Jackson, Gregory J Modrall, William J KaiserAbstract: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: Todd P Belott, Timothy Dickason, Mark R Jackson, Gregory J Modrall, William J KaiserAbstract: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 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.
Gregory J Modrall - One of the best experts on this subject based on the ideXlab platform.
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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: Todd P Belott, Timothy Dickason, Mark R Jackson, Gregory J Modrall, William J KaiserAbstract: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: Todd P Belott, Timothy Dickason, Mark R Jackson, Gregory J Modrall, William J KaiserAbstract: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 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.
Stephen E Fremes - One of the best experts on this subject based on the ideXlab platform.
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angiographic outcome of coronary artery bypass Grafts the radial artery database international alliance
The Annals of Thoracic Surgery, 2020Co-Authors: Mario Gaudino, Stephen E Fremes, Umberto Benedetto, David L Hare, Philip A R Hayward, Neil Moat, Marco Moscarelli, Antonino Di Franco, Giuseppe NassoAbstract:Background We used a large patient-level data set including 6 angiographic randomized controlled trials (RCTs) on coronary artery bypass conduits to explore incidence and determinants of coronary Graft failure. Methods Patient-level angiographic data of 6 RCTs comparing long-term outcomes of the radial artery and other conduits were joined. Primary outcome was Graft Occlusion at maximum follow-up. The analysis was divided as (1) left anterior descending coronary (LAD) distribution and (2) non-LAD distribution (circumflex and right coronary artery). Mixed-model multivariable Cox regression including all baseline characteristics with stratification by individual trials was used to identify predictors of Graft Occlusion. Results Included were 1091 patients and 2281 Grafts, consisting of 921 left internal mammary arteries, 74 right internal mammary arteries, 710 radial arteries, and 576 saphenous veins. All left internal mammary arteries were used on the LAD, the other conduits were used on the non-LAD distribution. Mean angiographic follow up was 65 ± 29 months. Occlusion rates were 2.3% for the left internal mammary arteries, 13.5% for the left internal mammary arteries, 9.4% for the right internal mammary arteries, and 17.5% for the saphenous veins. At multivariable analysis, type of conduit used, age, female sex, left ventricular ejection fraction of less than 0.50, and use of the Y Graft were significantly associated with Graft Occlusion in the non-LAD distribution. Conclusions Our analyses showed that failure of the left internal mammary arteries-to-LAD bypass is a very uncommon event. For the non-LAD distribution, the nonuse of radial artery, age, female sex, left ventricular ejection fraction of less than 0.50, and use of the Y Graft configuration were significantly associated with midterm Graft failure.
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radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery results from raps radial artery patency study
Journal of the American College of Cardiology, 2012Co-Authors: Saswata Deb, Eric A Cohen, Steve K Singh, Dai Une, Andreas Laupacis, Stephen E Fremes, Raps InvestigatorsAbstract:Objectives The purpose of this study was to present radial and saphenous vein Graft (SVG) Occlusion results more than 5 years following coronary artery bypass surgery. Background In the RAPS (Radial Artery Patency Study) study, complete Graft Occlusion was less frequent in radial artery compared with SVG 1 year post-operatively while functional Occlusion (Thrombolysis In Myocardial Infarction flow grade 0, 1, 2) was similar. Methods A total of 510 patients 70% proximal stenosis. Within-patient randomization was performed; the radial artery was randomized to either the right or circumflex territory and the study SVG was used for the other territory. The primary endpoint was functional Graft Occlusion by invasive angiography at least 5 years following surgery. Complete Graft Occlusion by invasive angiography or computed tomography angiography was a secondary endpoint. Results A total of 269 patients underwent late angiography (234 invasive angiography, 35 computed tomography angiography) at a mean of 7.7 ± 1.5 years after surgery. The frequency of functional Graft Occlusion was lower in radial arteries compared with SVGs (28 of 234 [12.0%] vs. 46 of 234 [19.7%]; p = 0.03 by McNemar's test). The frequency of complete Graft Occlusion was also significantly lower in radial compared with SVGs (24 of 269 [8.9%] vs. 50 of 269 [18.6%]; p = 0.002). Conclusions Radial arteries are associated with reduced rates of functional and complete Graft Occlusion compared with SVGs more than 5 years following surgery. (Multicentre Radial Artery Patency Study: 5 Year Results; NCT00187356 )
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impact of patient and target vessel characteristics on arterial and venous bypass Graft patency insight from a randomized trial
Circulation, 2007Co-Authors: Nimesh D Desai, Eric A Cohen, David C Naylor, Alexander Kiss, Randi Federelituv, Senri Miwa, Sam Radhakrishnan, James Dubbin, Leonard Schwartz, Stephen E FremesAbstract:Background— The purpose of this investigation was to determine optimal patient and target-vessel characteristics to maximize arterial and venous Graft patency on the basis of data from a large clinical trial. Methods and Results— Angiographic data on 440 radial artery Grafts and 440 saphenous vein Grafts were analyzed with methodology to account for within-patient clustering. Multivariable models that incorporated patient demographic, operative, anatomic, and postdischarge medical management were constructed to determine predictors of Graft Occlusion. Radial artery use was strongly protective against Graft Occlusion at 1 year after adjustment for all covariates, with a larger protective effect seen in women (P=0.05 for a subgroup-by-treatment interaction). Among all Grafts, diabetes and small target-vessel diameter were associated with an increased risk of Graft Occlusion, and Grafting to a target vessel with more severe proximal stenosis was associated with a decreased risk of Graft Occlusion. With regar...
Saswata Deb - One of the best experts on this subject based on the ideXlab platform.
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the long term impact of diabetes on Graft patency after coronary artery bypass Grafting surgery a substudy of the multicenter radial artery patency study
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Saswata Deb, Steve K Singh, Dai Une, Fuad Moussa, Hideki Tsubota, Alex Kiss, George TomlinsonAbstract:Objectives The study objective was to determine the impact of diabetes on radial artery and saphenous vein Graft Occlusion and clinical outcomes more than 5 years after coronary artery bypass surgery in the multicenter Radial Artery Patency Study (NCT00187356). Methods A total of 529 patients aged less than 80 years with triple-vessel disease undergoing coronary bypass surgery participated in this study. Angiographic follow-up occurred more than 5 years after surgery with annual clinical follow-up. The primary objective was to compare the proportion of complete Graft Occlusion between radial artery and saphenous vein Grafts among diabetic and nondiabetic persons. Additional objectives included determining predictors of complete Graft Occlusion and comparison of major adverse cardiac events defined by cardiac death, late myocardial infarction, and reintervention. Results There were 148 of 529 patients (27.8%) with diabetes; 269 patients (83/269 [30.9%] diabetic) underwent late angiography at mean of 7.7 ± 1.5 years after surgery. In diabetic patients, the proportion of complete Graft Occlusion was significantly lower in the radial Grafts (4/83 [4.8%]) than in the saphenous Grafts (21/83 [25.3%]) ( P = .0004), and this was similar in nondiabetic patients ( P = .19). Multivariate modeling showed that the use of the radial artery and high-grade target vessel stenosis were protective against late Graft Occlusion, whereas female gender, smoking history, and elevated creatinine were associated with an increased risk; interaction between diabetic status and conduit type also was significant ( P = .02). Major adverse cardiac events were higher in diabetic patients (23/148 [15.5%] vs 35/381 [9.2%], P = .04). Conclusions The use of the radial artery should be strongly considered in diabetic patients undergoing coronary bypass surgery, especially with high-grade target vessel stenosis.
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radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery results from raps radial artery patency study
Journal of the American College of Cardiology, 2012Co-Authors: Saswata Deb, Eric A Cohen, Steve K Singh, Dai Une, Andreas Laupacis, Stephen E Fremes, Raps InvestigatorsAbstract:Objectives The purpose of this study was to present radial and saphenous vein Graft (SVG) Occlusion results more than 5 years following coronary artery bypass surgery. Background In the RAPS (Radial Artery Patency Study) study, complete Graft Occlusion was less frequent in radial artery compared with SVG 1 year post-operatively while functional Occlusion (Thrombolysis In Myocardial Infarction flow grade 0, 1, 2) was similar. Methods A total of 510 patients 70% proximal stenosis. Within-patient randomization was performed; the radial artery was randomized to either the right or circumflex territory and the study SVG was used for the other territory. The primary endpoint was functional Graft Occlusion by invasive angiography at least 5 years following surgery. Complete Graft Occlusion by invasive angiography or computed tomography angiography was a secondary endpoint. Results A total of 269 patients underwent late angiography (234 invasive angiography, 35 computed tomography angiography) at a mean of 7.7 ± 1.5 years after surgery. The frequency of functional Graft Occlusion was lower in radial arteries compared with SVGs (28 of 234 [12.0%] vs. 46 of 234 [19.7%]; p = 0.03 by McNemar's test). The frequency of complete Graft Occlusion was also significantly lower in radial compared with SVGs (24 of 269 [8.9%] vs. 50 of 269 [18.6%]; p = 0.002). Conclusions Radial arteries are associated with reduced rates of functional and complete Graft Occlusion compared with SVGs more than 5 years following surgery. (Multicentre Radial Artery Patency Study: 5 Year Results; NCT00187356 )
Patrick G Clagett - 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, William O Williford, Willard C. Johnson, 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 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, William O Williford, Willard C. Johnson, 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.)
