Randomized clinical trial of distal anastomotic interposition vein cuff in infrainguinal polytetrafluoroethylene bypass grafting

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  • G D Griffiths
    Department of Vascular Surgery, Ninewells Hospital, Dundee DD1 9SY, UK
  • J Nagy
    Department of Vascular Surgery, Ninewells Hospital, Dundee DD1 9SY, UK
  • D Black
    Department of Vascular Surgery, Ninewells Hospital, Dundee DD1 9SY, UK
  • P A Stonebridge
    Department of Vascular Surgery, Ninewells Hospital, Dundee DD1 9SY, UK

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<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>The aim was to examine the effect of a Miller vein cuff at the distal anastomosis on the medium- to long-term patency and limb salvage rates of femoral to above-knee and femoral to below-knee popliteal artery polytetrafluoroethylene (PTFE) bypasses.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This study involved extended follow-up of the original cohort of patients included in a previously reported multicentre randomized clinical study. Outcome measures were bypass graft patency and limb salvage.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Two hundred and sixty-one bypass operations were originally randomized. For this study, full data were available on 235 (120 with a Miller cuff, 115 without). The cumulative 5-year patency rate for above-knee bypasses with a Miller cuff was 40 per cent, compared with 42 per cent for non-cuffed bypasses (P = 0·702). The cumulative 3-year patency rate for below-knee bypasses with a Miller cuff was 45 per cent, compared with 19 per cent for non-cuffed bypasses (P = 0·018). A Miller cuff had no significant effect on limb salvage for above-knee or below-knee bypasses.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Three-year patency rates of femoral to below-knee popliteal PTFE bypasses were improved by a Miller cuff. Miller cuffs had no effect on patency rates for femoral to above-knee popliteal bypasses at 5 years and did not improve limb salvage in either group.</jats:p> </jats:sec>

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