"Half and half" woven and knitted Dacron grafts in the aortoiliac and aortofemoral positions: seven and one-half years follow-up

Prospective randomized trial of woven versus collagen-impregnated knitted prosthetic Dacron grafts in aortoiliac surgery

BACKGROUND

Despite the theoretical advantages of coating knitted grafts with a material designed to reduce blood loss, their performance has not been directly compared with woven grafts in a prospective randomized trial. The aim of this study was to compare the graft handling qualities and operative blood loss of the two types of arterial prosthesis, as well as complication rate and patient survival at 1 year.

METHODS

A total of 267 consecutive patients having surgery for occlusive or aneurysmal disease of the aortoiliac arteries were randomized to receive woven (141 patients) or knitted collagen-impregnated Dacron (126 patients) grafts. Graft patency was assessed on discharge and at 1 year by duplex imaging.

RESULTS

Mean(s.d.) intraoperative blood loss was statistically greater with woven grafts (1690(1424) ml) compared with knitted (1363(1172) ml) (P = 0.049). An insignificant 1-year increase in mean(s.d.) graft diameter of 1.2(0.2) mm was found at the distal anastomosis in the knitted group. There was no difference in graft patency between the groups and only one graft became infected.

CONCLUSION

This study suggests that knitted and woven grafts have similar clinical performance and therefore the less expensive material (woven) should usually be selected unless haemorrhagic complications are anticipated.

Current controversies in the management of aortoiliac occlusive disease

The numerous options currently available for treatment of aortoiliac occlusive disease have led to considerable controversy in regard to the optimal method of revascularization in such patients. Differences of opinion exist not only with respect to certain technical aspects of direct anatomic aortic reconstruction, which has traditionally been regarded as the "gold standard" treatment, but even more importantly as to whether alternative methods including a variety of catheter-based endoluminal therapies and extraanatomic grafts may offer nearly equivalent results with less risk and possible cost advantages. Although little truly definitive data is available, a review of published information can help clarify many of these management dilemmas. In the final analysis, the various methods may not be as competitive with one another as first seems apparent. Each has its own specific advantages and disadvantages and when used, in appropriate circumstances can provide excellent results. Indeed, it is this broad spectrum of options that can be matched to each patient's own unique anatomic and risk characteristics that make treatment of aortoiliac disease one of the most successful areas of contemporary vascular surgery practice.