Vascular prosthesis graft bypass in the treatment of 78 patients with Leriche syndrome

Chunxi WANG; Gang CHEN; Faqi LIANG; Zheng PENG

ABSTRACT

BACKGROUND:

Effective drugs for improving vascular elasticity and revascularization are few for treating Leriche syndrome (chronic lower extremities ischemia) induced by abdominal aortic occlusion.Vascular outflow tract reconstruction in vascular prosthesis transplantation can rapidly improve blood supply in the distal extremities.

OBJECTIVE:

To evaluate the biocompatibility and outcome of vascular prosthesis transplantation for the treatment of Leriche syndrome.

DESIGN:

Controlled study before and after surgery.

SETTING:

Department of General Surgery of General Hospital of Chinese PLA and Department of Thoracic and Cardiovascular Surgery of Shijingshan Hospital.

PARTICIPANTS:

Sixty-two patients and sixteen patients with Leriche syndrome were enrolled in this study,who were respectively from Department of General Surgery of General Hospital of Chinese PLA between January 1995 and January 2007 and from Department of Thoracic and Cardiovascular Surgery of Shijingshan Hospital between January 2001 and January 2007.The subjects were 66 males and 12 females,whose age ranged from 46-75 years (averagely 58 years) and onset time from 6 months-8 years (averagely 2 years and 6 months).Informed consents were obtained from all patients.

METHODS:

After general anaesthesia or epidural anesthesia,vascular bypass was performed,including aortofemoral bypass in 63 cases and aortoiliac bypass in 15 cases.Vascular prostheses included polytetrafiuoroethylene (FIFE)vascular prosthesis in 18 cases and polyester vascular prosthesis in 60 cases.PTFE vascular prosthesis (Gore,USA) is a kind of inert material with low biological response.Its fibers with micropores arrange irregularly.Polyester vascular prosthesis (Intervascular,France) is a kind of knitting polyester products,which is made from high-purity cattle collagen Ⅰ with high biocompatibility.To inlay heparin molecules that can retain 4 weeks into the surface of vessels coated with collagen can prevent thrombogenesis and inhibit hyperplasy of smooth muscle cells (SMC).The type is IGK1608;internal diameter of the bole is 16 nun; internal diameter of the branch is 8 mm.Therapeutic prescriptions were approved by Hospital's Ethics Committee.Follow-up was performed for 3 months-5 years by vascular Color Doppler Sonography,spiral CT angiography (SCTA) three-dimensional reconstruction or digital subtraction angiography (DSA) in hospital.MAIN OUTCOME

MEASURES:

Biocompatibility of vascular prosthesis and outcome of vascular prosthesis transplantation.

RESULTS:

Three months after vascular prosthesis transplantation,thrombus was not detected on vascular anastomosis and in vascular prosthesis by Color Doppler Sonography and SCTA.Seventy-seven patients were followed up for over one year,and their stomas were unobstructed.Seventy-six patients were followed up for over five years,and the patency rate of stomas was 89% (68/76).No changes in blood plaque,lencocyte count,haematoglobin or liver and kidney function were found after transplantation.Seven days after surgery,affected extremities with ischemic symptom were improved.Three months later,ischemic symptom disappeared.

CONCLUSION:

With good biocompatibility of vascular prosthesis,vascular prosthesis transplantation in the treatment of Leriche syndrome has a good outcome following aortofemoral bypass and aortoiliac bypass.