The effect of cigarette smoking on the long term success rates of aortofemoral and femoropopliteal reconstructions.

Cigarette smoking is a recognized causative factor in the genesis of arterial insufficiency, but the precise effect of nonsmoking on the success of the operation is not well documented. Three hundred and twenty-six patients who underwent aortobifemoral bypass (209) or femoropopliteal bypass (117) between 1969 and 1978 were observed to determine whether or not the discontinuation of cigarette smoking affected the long term results of these grafts. Patients were divided into three groups: group 1 smoked preoperatively and postoperatively; group 2 smoked preoperatively but not postoperatively, and group 3 did not smoke at all. The five year cumulative success rates for aortobifemoral bypass in the groups were: 42 per cent for group 1 (130 patients); 77 per cent for group 2 (67 patients), and 71 per cent for group 3 (12 patients) (p less than 0.001). In the femoropopliteal group, the variation with regard to the known patency rates of autogenous and prosthetic grafts made the results more difficult to assess. For all grafts the five year cumulative success rates were: 38 per cent of group 1 (57 patients); 33 per cent for group 2 (40 patients), and 70 per cent for group 3 (20 patients) (p less than 0.001). Subdivision of groups 1 and 2 into autogenous and synthetic grafts gave identical success rates of 54 per cent for long saphenous vein grafts (66). Prosthetic grafts were successful at five years in 19 per cent of the patients in group 1 (16 patients) and 43 per cent in group 2 (15 patients). These results were not significant. These results clearly favor the postoperative nonsmoker over the smoker in the aortofemoral group but the distinction in the femoropopliteal group is less clear, although there is a similar trend.

Femoropopliteal bypass: saphenous vein and expanded polytetrafluoroethylene grafts.

The patency of 181 saphenous vein and expanded polytetrafluoroethylene (PTFE) femoropopliteal bypass grafts was assessed during a follow-up that ranged from 1 to 53 months after operation. Significantly better patency (P less than 0.05) was noted with saphenous vein (70%) than with PTFE (56%). Life-table analysis at 30 months demonstrated a cumulative patency of 50% for saphenous vein grafts versus 39% for PTFE, while at 53 months the rates were 46% and 33% respectively. The PTFE grafts tended to occlude earlier than saphenous vein grafts but after the initial year, both types of graft failed at a rate of about 5% a year. Patency was similar in both groups when operation was performed for claudication, but for limb salvage operations saphenous vein patency was superior to PTFE. Although the groups were similar in constitution, a higher percentage of patients in the PTFE group had undergone previous vascular operations.