RANDOMIZED TRIAL COMPARING INFRAINGUINAL POLYTETRAFLUOROETHYLENE BYPASS-GRAFTING WITH AND WITHOUT VEIN INTERPOSITION CUFF AT THE DISTAL ANASTOMOSIS

Purpose: A multicenter randomized prospective study was undertaken to determine whether an interposition vein cuff improved the short-term a nd medium-term patency and limb salvage rates of femoral-above-knee an d femoral-below-knee popliteal artery polytetrafluoroethylene (PTFE) b ypass procedures. Methods: Two hundred sixty-one bypass operations wer e randomized (133 to vein cuff and 128 to no vein cuff). One hundred f ifty grafts were to the above-knee popliteal artery, 96 to the below-k nee popliteal artery, and 15 to tibial vessels. The median follow-up w as 617 days. Results: The 12-month patency rates for cuffed and uncuff ed above-knee popliteal artery PTFE bypass grafts were 80% and 84%, an d the 2-year patency rates were 72% and 70%, respectively. The patency rates for bypass grafts to the below-knee popliteal artery at 12 mont hs were 80% and 65% and at 2 years 52% and 29%, respectively (p = 0.03 ). At the below-knee site, this was reflected in 24-month difference i n limb salvage rates of 84% and 62%, respectively (p = 0.08).Conclusio ns: There was no improvement in the patency rate with the use of a dis tal anastomosis interposition vein cuff in femoral-above-knee poplitea l PTFE; bypass grafts, but there was a statistically significant advan tage when PTFE bypass grafts were anastomosed to the popliteal artery below the knee.