EFFECT OF EXTERNAL REINFORCEMENT ON THE PATENCY OF INFRAINGUINAL POLYTETRAFLUOROETHYLENE ARTERIAL GRAFTS

BACKGROUND: Expanded polytetrafluoroethylene (PTFE) has been used for infrainguinal revascularization when the saphenous vein is unavailable or unsuitable, Patency rates are, however, decidedly inferior to thos e with autologous vein, especially when anastomosed distally to the in frageniculate popliteal or tibial arteries, Although there are theoret ical advantages to the use of reinforced grafts, the issue of external support for infrainguinal grafts has not been addressed in large clin ical trials, Despite the insufficiency of data to support their use, e xternally supported PTFE grafts are widely used in clinical practice, This study attempts to determine whether or not external reinforcement of PTFE grafts affects patency when the graft crosses a joint in a ca nine arterial model. STUDY DESIGN: Patency rates of standard PTFE pros theses were compared with those of externally supported PTFE across th e hip joint in 19 mongrel dogs, In each animal, one Limb was randomly assigned to receive standard PTFE and the other, externally supported PTFE, External iliac-superficial femoral artery grafts were constructe d in a standardized fashion, At 12 to 16 weeks after implantation, gra ft patency was assessed by arteriography. RESULTS: Thirteen animals (2 6 grafts) underwent angiographic evaluation of patency, Overall patenc y was 42 percent at 84 to 113 days, There was no statistically signifi cant difference in patency between the two graft materials. CONCLUSION S: Intrinsic factors, rather than the presence or absence of external graft reinforcement, are the most important determinants of graft pate ncy in this model, These data do not support the routine clinical use of externally reinforced PTFE grafts for infrainguinal revascularizati on.