With development of new grafts many surgeons prefer to do the proximal femoral-to-popliteal bypass with synthetic prosthesis even if saphenous vein is avaliable. I'm looking for evidence-based bibliographic references that can state against this approach.
Dear Dumitri,
I have two RCTs from two friends and compatriots of mine (Pieter Klinkert and Fob van Det) whose publications I have uploaded and one excellent review for which I attached the link.
Vascular surgeons that prefer prothetic grafts over autologous vein grafts in infrainguinal bypass surgery are, in my opinion, lazy and ignorant of overwhelming evidence condemning that practice and should be sued by their patients who run a real risk for losing their leg(s)!
Dear Cornelis!
Thank you very much for prompt unswer and provided references. I'm completely agree with you. In the discussions, my opponents (supporters of graft-first strategy) states that in this way vein can be preserved for further (eventually more complex - more distal?) reconstruictions in case of synthetic graft failure. That do you think about this "argument"?
That is a fallacy for their laziness. Do not forget that prosthetic bypasses before they clot completely very frequently have emboli zed their lower leg arteries and these patients readily lose their legs! So, yes they will be served on their command! However in those cases with old thrombi in lower leg arteries you need a lot of skill and luck to keep these legs alive. See also: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549649/. So why would not we do our best job in the first place for that poor patient?
I am sure to have read once that in only 3% cardiac surgeons found the GSV they wanted to use gone, but these guys know to use LIMA, RIMA and autologous arm veins as well, so our use of the best material for our surgery does not pose a real problem to cardiac surgeons.
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