26 Six Year Prospective Multicenter Randomized Comparison of Autologous Saphenous Vein and Expanded скачать в хорошем качестве

26 Six Year Prospective Multicenter Randomized Comparison of Autologous Saphenous Vein and Expanded

#VascularSurgery #LimbSalvage #PTFEGrafts #VeinGrafts #BypassSurgery #MedicalResearch #ClinicalTrial #AmputationPrevention #SurgicalHistory #LandmarkStudy This video discusses a landmark study that challenged the established practice of amputation for severe leg blockages. Instead, it focused on an aggressive surgical approach involving bypasses to restore blood flow and save the limb. This strategy faced initial skepticism, as surgeons proposed complex operations on patients often considered candidates only for amputation. The proponents of this aggressive approach meticulously documented over 2,800 cases, demonstrating a surprisingly low procedural mortality of about 3%. Crucially, 66% of these patients maintained a functional limb after more than five years. This led to their own major amputation rates plummeting from 49% to just 14% over 16 years, providing real-world data supporting aggressive limb salvage. A key challenge was finding suitable graft material when the patient's own saphenous vein, typically preferred for its good long-term patency, was unavailable. PTFE synthetic grafts became an alternative around 1978. Despite positive early results, the wider surgical community remained skeptical of PTFE. This highlighted the need for robust, comparative data, leading to a landmark randomized trial comparing vein and PTFE grafts for limb salvage below the groin. This study was driven by clinical need rather than industry funding. The findings were nuanced. For popliteal bypasses (around the knee), PTFE performed similarly to vein for the first two years, although vein had better long-term primary patency. However, ultimate limb salvage rates were the same for both, often achieved through reinterventions on PTFE grafts. For the more challenging tibial/peroneal bypasses (below the knee), vein grafts clearly showed better primary patency. Yet, even in these cases, ultimate limb salvage rates were equally good with both graft types after repeat operations. This led to the authors' "heretical conclusion": performing a PTFE bypass to tibial arteries was worthwhile if a good vein was absent and amputation was the only alternative. This pragmatic, patient-centered view, supported by data and compelling anecdotes, fundamentally shifted the paradigm. It fueled global acceptance of aggressive limb salvage and showed that PTFE grafts offered a real chance to save limbs, even below the knee, providing hope where there was previously resignation to amputation. The study underscores the vital importance of rigorous research in challenging deeply held beliefs to advance medicine. The field continues to evolve, building upon this foundational work. This video summary is part of a series on "50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know".