Impact of Adjunct Femoral Patch Reconstruction on Graft Patency after Below the Knee Popliteal Bypass Implantation

Introduction: Acknowledging the superior long term patency of infrainguinal saphenous bypass to distal popliteal artery, debate continues regarding the choice of alternative conduits and possible surgical adjuncts to improve infl ow and graft salvage. The objective of this retrospective study was to determine the effectiveness of proximal anastomotic patch as adjunct to open surgical below the knee popliteal revascularization. Material and Methods: In a series of 132 distal popliteal bypass operations 63 non-reversed vein, 18 in situ vein and 51 Omnifl ow bypass conduits were used. Proximal anastomotic patch was applied in overall 28 patients: 19% in the non-reversed (12 patients), 50% in the in situ group (9 patients) and 13.7% in the Omni fl ow group (7 patients). Results: The reintervention rate was 7.9% in the non-reversed, 33.3% in the in situ and 31.4% in the Omnifl ow group. The most often complication was the proximal anastomotic stenosis (5.3%), followed by bleeding (3%), infection (1.5%) and distal anastomotic stenosis (1.5%). Patch reconstruction did not decrease incidence of reoperation (21.4% vs. 21.2% in the non-patch group), nor signifi cantly infl uence bleeding, infection or thrombosis, however it reduced the overall rate of proximal anastomosis stenosis (0% vs. 6.7%, p=) and signifi cantly improved patency rate at 3 years in the in situ group compared to the non-patch group (100% vs. 55.6%, p=0.02). Conclusions: Adjunct proximal anastomotic patch has signifi cantly enhanced primary graft patency rate of the situ femoropopliteal below the knee bypasses and reduced proximal anastomotic stenosis after prosthetic bypass implantation. Non-reversed vein bypasses did not profi t from this adjunct neither in terms of patency nor in terms of early complications. Further randomized data is needed to ascertain whether this information translates into improvement in limb survival after in situ venous grafting. Research Article Impact of Adjunct Femoral Patch Reconstruction on Graft Patency after Below the Knee Popliteal Bypass Implantation Terézia B Andrási1,2, Elke Dorner1,2, Christof Kindler2, Dieter Zenker1, Christian F Vahl2 and Friedrich A. Schöndube1 1Department of Thoracic, Cardiac and Vascular Surgery, Georg-August University, Göttingen, Germany 2Department of Cardiac, Thoracic and Vascular Surgery, Johannes Gutenberg University Clinic, Mainz, Germany Dates: Received: 28 November, 2016; Accepted: 30 December, 2016; Published: 31 December, 2016 *Corresponding author: Terézia B. Andrási, MD, PhD, Department of Thoracic, Cardiac and Vascular Surgery, University of Göttingen, Robert Koch Str. 40, 37075 Göttingen, Germany, Tel: +49-201-2802211; Fax: +49-201-2802213; E-mail: