COMPARISON OF CONDUIT PATENCY AND ROLE OF
ANTICOAGULANTS IN LONGITIVTIY OF PROSTHETIC GRAFT VERSUS
AUTOLOGOUS SAPHENOUS VEIN FOR BELOW KNEE BYPASS GRAFTING
IN CRITICAL LIMB ISCHEMIA
Authors: Chandel Nishant Singh , Sahu Krishnakant 
Published: March 2020

BACKGROUND: As established fact the autogenous vein is the conduit of choice in below-knee arterial bypasses .
However, with availability of newer prosthetic grafts and usage of anti-platelets and anticoagulants , the results of these
prosthesis's are also improving. so much so that in case of non availability of good GSV or malnourished patients where wound healing could be
a concern prosthetic grafts can be used reasonably well.
We also compared the outcomes of below-knee prosthetic versus autologous vein bypass grafts with different anti-platelets and anti-thrombotic
medicines combinations to nd out whether the prosthesis performance improves with anticoagulants usage and whether the addition of
anticoagulants to anti-platelets is causing more bleeding complications in these patients so much that they are to be used with caution.
METHODS: For this study, we utilised treatment data of Department of CardioVascular and Thoracic Surgery ,Pt. J.N.M. Medical
College Raipur. we studied 70 patients, Single surgeon experience. We included patients who underwent open below knee bypass procedure for
critical limb ischemia (claudication/ rest pain/ non healing ulcers/ gangrenous changes) between January 1, 2018 and December 31, 2019. Our
analysis was limited to patients whose graft origins were the ipsilateral iliac or femoral arteries and whose targets were the below-knee popliteal
or tibial arteries.
We analysed the results by evaluating the Graft Patency at 1 year, major amputation at 1 year, bleeding complications, association of bleeding
complications to the combination of anti-platelets + anticoagulation.
we also evaluated the patency at 1 year in relation to the distal anastomotic sites ( popliteal or infra popliteal ) and amputation in relation to the
distal targets for bypass to understand that the disease load has any signicance in the patency and limb salvage in patients of lower limb
ischemia.
RESULTS :Atotal of 70 patients who underwent open below knee bypass procedure for critical limb ischemia were analysed; 35 patients (50%)
received GSV and 35 patients (50%) received a prosthetic conduit. There was no signicant difference in primary patency due to Gender (Male
84.3%, Female 15.7%), Diabetes Mellitus (GSV 20%, Prosthetic 14.3%), Hypertension (GSV 31.4%, Prosthetic 45.7%) & Tobacco addition
(GSV 100%, Prosthetic 94.3%). Baseline characteristics were similar among groups with the popliteal artery (54.3%) and infra popliteal
arteries. i.e. tibioperoneal trunk (27.1%), Anterior Tibial (4.3%) and posterior tibial (14.3%). We found no signicant difference in primary graft
patency (77% vs 71%, P= ) or major amputation rates (8.5% vs 17%, P= ) between GSVand Prosthetic conduit. The prosthetic graft patency was
more when the anti platelets were combined with anticoagulants. Saphenous vein graft patients did well even with anti platelets single or
combination. Bleeding complications were more common in the prosthetic group with anti platelets with anticoagulants.
CONCLUSIONS:Although limited in size, our study demonstrates that, with appropriate patient selection and anti-thrombotic therapy, 1-year
outcomes for below-knee prosthetic bypass graft can be comparable to those for greater saphenous vein conduit.Though the study does not
challenge the superiority of vein graft for below knee bypass grafting , but in certain cases where needed prosthetic graft are denitely
comparable in performance.