COMPOSITE POLYTETRAFLUOROETHYLENE VEIN BYPASS GRAFTS - CONVENTIONAL DISTAL VEIN SEGMENT OR VEIN CUFF/

Objectives: To determine the current status of PTFE vein composite gra fts, we reviewed our experience with 205 composite reconstructions and compared the results of conventional distal vein segment to that of d istal vein cuff. Design: Retrospective review. Setting: Department of Surgery, University Hospital. Patients and methods: The series include d 85 women and 102 men with a median age of 70. The indications for su rgery were claudication in 30, rest pain in 71 and ulcer/gangrene in 1 03. The site of the distal anastomosis was the popliteal artery in 111 and crural artery in 94. The graft consisted of a proximal PTFE graft anastomosed to a distal segment of reversed saphenous vein in 169 or to a modified distal Miller cuff in 36 operations after 1992. Results: Cumulative life table primary patency rates for the whole series at 1 2, 24 and 36 months were 39%, 32% and 25% respectively. Limbs with goo d run-off demonstrated significantly better patency rates compared to limbs with poor run-off (55% and 17% at 12 months, 35% and 11% at 36 m onths, p=0.04). The patency rate of femorocrural grafts with poor run- off was only 4% at 12 months. The overall limb salvage rates at 12 and 36 months were 63% and 55%, respectively. Similar results were obtain ed in limbs with distal reversed vein segment and distal vein cuff. Co nclusion: The results of this study suggest that for infrainguinal byp ass grafting where the saphenous vein is unavailable, a composite PTFE -vein graft might be an acceptable alternative in limbs with good run- off. Although not a randomised study, the results using a distal rever sed vein segment or a cuff were similar.