Koji Dairaku

Experimental and Clinical Studies Investigating the Efficacy of Distal Anastomosis with Patch Plasty in Bypass Operations with Expanded Polytetrafluoroethylene Grafts

Abstract.Purpose: We investigated the efficiency of distal anastomosis with patch plasty (DAPP), both experimentally and clinically. Methods: In our experimental study, dogs were divided into two groups: a control group in which anastomosis was performed without DAPP (n = 7), and a DAPP group in which DAPP was performed at the distal anastomosis (n = 7). In our clinical study, 169 femoropopliteal bypasses were divided into three groups and analyzed. In one group, the saphenous vein was used (SVG group, n = 65); in one group, an expanded polytetrafluoroethylene (ePTFE) graft was used without DAPP (ePTFE group, n = 64); and in one group, an ePTFE graft was used with DAPP (DAPP group, n = 40). Results: In the experimental study, the ratio between the area of thrombus adherence and the entire area of the intraluminal surface of the graft, defined as the thrombus covering ratio, was 48.9% in the control group and 30.2% in the DAPP group. The ratio in the DAPP group was significantly lower than that in the control group. In the clinical study, although there were no significant differences among the three groups in cumulative patency rates of the femoral above-knee popliteal arterial bypasses, the patency in the DAPP group was excellent. The cumulative patency rates of the femoral below-knee popliteal arterial bypasses in the ePTFE group were significantly lower than those in the other two groups. Conclusion: There results suggest that the addition of DAPP may achieve excellent graft patency.