Heparin-Bonded Vascular Grafts Outperform Teflon-Coated Versions

A new study has shown that a heparin-bonded expandable polytetrafluoroethylene (PTFE) graft is superior to a Teflon-coated graft in reducing occlusion in patients with peripheral artery disease (PAD).

Researchers at Viborg Hospital (Denmark) conducted a randomized multicenter trial that involved 569 patients with symptomatic PAD from 11 Scandinavian centers. All patients had femoral bypass or femoropopliteal bypass planned. The patients were randomized to the heparin-bonded PTFE graft or the Teflon-bonded PTFE graft.

Overall, 546 patients (96%) completed the study with one year of follow-up. The researchers measured graft patency at one year using duplex ultrasonography (US), but did not assess limb function or ability to walk due to financial constraints.

The results showed that one-year primary patency was 86.4% for the heparin-bonded graft and 79.9% for the Teflon-bonded graft, representing a relative risk reduction of 36%; one-year secondary patency was 88% for the heparin-bonded graft and 81% for the Teflon-bonded graft. In a subset of around 200 patients with critical limb ischemia, a 50% relative risk reduction was observed in favor of the heparin-bonded PTFE graft. Patients with limb-threatening ischemia who required a femoral artery bypass had an even higher relative risk reduction of 66% favoring the heparin-bonded graft. The study was presented at the 37th annual VEITH Symposium, held during November 2010 in New York (NY, USA).

"Results favoring the heparin-bonded stretch PTFE graft were more robust in those with critical ischemia of the lower extremities, and were most robust in patients with limb-threatening ischemia,” said lead author and study presenter Jes Lindholt, MD. "The heparin-bonded graft kept its promises from earlier prospective studies. This was not just statistically significant; it was clinically significant as well.”

"The concept of coating grafts and stents has been around for about a decade,” commented Iris Baumgartner, MD, a professor of medicine and head of clinical and interventional angiology at University Hospital Bern (Switzerland). "Theoretically and biologically, it makes sense to directly inhibit the coagulation cascade with this approach. Until now, none of the coatings has shown clinically relevant results.”

Related Links:
Viborg Hospital
University Hospital Bern