THE LONG-TERM VALUE OF COMPOSITE GRAFTS FOR LIMB SALVAGE

Purpose: We determined the long-term efficacy of composite grafts for limb salvage when autogenous vein grafts were not available. Methods: After arterial bypass, the 8-year primary and secondary patency, limb salvage, and mortality rates were compared by life-table analysis. One hundred twenty-five patients had 130 composite grafts for 27 femoropo pliteal bypasses, 48 femorotibial bypasses, and 55 sequential femoropo pliteotibial bypasses. Three hundred forty patients had autogenous vei n grafts for 247 femoropopliteal bypasses and 114 femorotibial bypasse s. Seventy-two patients had 82 femoropopliteal prosthetic grafts. Resu lts: Eight-year primary and secondary patency rates were 56% and 62% f or femoropopliteal procedures with composite grafts, respectively, and 53% and 59% for autogenous vein grafts, respectively. The secondary p atency rate for polytetrafluoroethylene grafts was 35% and was less (p < 0.05) than the rate for the vein grafts. Secondary patency rates fo r femorotibial procedures were 66% for the vein grafts, 56% for single outflow composite grafts, and 52% for dual outflow composite grafts. Limb salvage rates for femoropopliteal procedures were 73% for composi te grafts, 63% for polytetrafluoroethylene, and 82% for vein grafts, a nd for femorotibial procedures were 53% for single outflow composite g rafts, 65% for dual outflow composite grafts, and 86% for vein grafts. Conclusions: Composite grafts achieve long-term preservation of ische mic limbs in patients who are facing limb loss because of poor run-off and have insufficient autogenous vein for a graft.