IS SURVEILLANCE TO DETECT FAILING POLYTETRAFLUOROETHYLENE BYPASSES WORTHWHILE - 12-YEAR EXPERIENCE WITH 91 GRAFTS

Purpose: The purpose of this study was to review the 91 failing polyte trafluoroethylene (PTFE) grafts that were treated at our institution o ver the past 12 years to better understand their cause and improve the diagnosis and treatment of these grafts. Methods: Eighty-five patient s with 91 failing grafts were retrospectively reviewed. The 144 graft- threatening lesions associated with these grafts were characterized by location (inflow artery, outflow artery, anastomosis, or graft body) and treatment method used (surgery, balloon angioplasty, or thrombolys is).Results: Progression of atherosclerotic disease was the predominan t cause of failing PTFE grafts with 43 inflow lesions and 83 outflow l esions, accounting for 87% of all lesions identified. Ten lesions (7%) were noted within the prosthetic grafts, whereas only eight (6%) lesi ons were noted at the anastomoses. Forty stenotic lesions 2 cm in leng th or less were treated with percutaneous transluminal balloon angiopl asty, whereas 100 lesions were treated by patch angioplasty or graft e xtensions. The remaining four lesions, present within the prosthetic g rafts, were treated with thrombolytic therapy. The B-year cumulative p atency rate for all failing PTFE grafts was 71%, whereas that of faili ng femoropopliteal PTFE grafts was 64%. The 5-year limb salvage rate f or all failing PTFE grafts was 73%. Conclusions: The progression of in flow and outflow disease is the predominant cause of failing PTFE graf ts, which suggests that this process is a more important cause of PTFE graft thrombosis than is generally recognized. Frequent PTFE graft su rveillance may permit detection of some threatening lesions before gra ft thrombosis occurs and may help maintain and prolong graft patency. The enhanced 5-year patency and limb salvage rates for treated failing PTFE grafts compared with the known poor outcome after reintervention s for PTFE graft failure support the conclusion that surveillance of P TFE grafts is worthwhile.