Does an adjuvant AV-fistula improve the patency of a femorocrural PTFE bypass with distal vein cuff in critical leg ischaemia?: A prospective randomised multicentre trial

Introduction. A lack of suitable veins can cause serious problems when attempting to revascularise critically ischaemic legs. Prosthetic grafts have much worse patency in the femocrural position, despite the use of distal anastomotic cuffs. The use of adjuvant AV fistula at the distal anastomosis should increase the graft flow above the thrombotic threshold velocity and thus increase prosthetic graft patency. Aim. The aim of the study was to evaluate the benefit of an adjuvant AV fistula on the patency of a femorocrural PTFE bypass with a distal vein cuff. Materials and methods. This prospective randomised multicentre trial was conducted in four centres. A total of 59 patients with critical leg ischaemia and no suitable veins for grafting were randomised to receive a femocrural PTFE bypass and distal vein cuff; with or without an adjuvant AV fistula. Thirty-one patients were randomised to the AV-fistula group (AVFG) and 28 to the control group (CG). Six patients were lost to follow-up during the 2-year study time. Results. There were six immediate occlusions in each treatment group, but half of these were saved by re-operation. The mean postoperative ankle-bachial index (ABI) was 0.85 in the AVFG and 0.94 in the CG. The primary and secondary patency rate at 2 years was 29 and 40% for the AVFG and 36 and 40% for the CG (NS). Leg salvage at 2 years was 65 and 68%, respectively (NS). Conclusion. Adjuvant AV fistula does not improve the patency of a femorocrural PTFE bypass with a distal vein cuff.