J. Devin B. Watson1, Jonathan J. Morrison3, Irma L. McNamee2, Thomas W. Evans2, Todd E. Rasmussen2
1San Antonio Military Medical Center, San Antonio, TX; 2US Army Institute of Surgical Research, Fort Sam Houston, TX; 3Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
OBJECTIVES: Reconstruction of vascular injury often requires autologous vein (AV) or expanded polytetrafluoroethylene (ePTFE) conduit. To date, the durability of ePTFE as an adjunct to vascular repair in the combat setting is unknown. The objective of this study is to compare the long-term effectiveness of ePTFE to AV in repair of wartime vascular injury.
METHODS: U.S. service personnel undergoing vascular repair (2002-2012) were identified. Patients in whom ePTFE was used as an interposition conduit (n=25) were matched to those who received AV (n=24). Injury and operative factors were assessed and freedom from graft-related complication quantified using Kaplan-Meier log-rank test.
RESULTS: Follow-up for the ePTFE and AV groups was 71 and 62 months, respectively. There was no difference between ePTFE and AV groups in age, injury severity or mangled extremity severity scores. In the overall cohort, there was an apparent but not significantly greater freedom from graft-related complication for AV compared to ePTFE (65.4% vs. 17.1%; p=0.13). In the extremity position, AV demonstrated greater freedom from graft-related complication than ePTFE (Figure 1). In the carotid/subclavian/axillary positions, ePTFE performed equally well as AV (p=0.9).
CONCLUSIONS: Autologous vein is a more durable conduit than ePTFE in repair of wartime extremity vascular injury, while ePTFE is effective and durable in the carotid, subclavian and axillary locations.
AUTHOR DISCLOSURES: T. W. Evans: Nothing to disclose; I. L. McNamee: Nothing to disclose; J. J. Morrison: Nothing to disclose; T. E. Rasmussen: Nothing to disclose; J. B. Watson: Nothing to disclose.
Figure 1 displays FGRC in extremity PTFE grafts was 15.4%/8.05 year and 76.9%/8.05year for extremity autologous vein grafts (p=0.044).
Posted April 2013