THE INFLUENCE OF GRAFT TYPE ON PATENCY OF INFRAINGUINAL ARTERIAL BYPASS GRAFTS

Between 1985 and 1992, 328 patients underwent 392 infrainguinal recons tructions. Indications for operation were disabling claudication in 12 6 patients, critical limb ischemia in 246 and uncomplicated popliteal aneurysm in 20. Grafts were to the above knee pop liteal artery in 134 patients, below knee popliteal artery in 176 and infrapopliteal (''di stal'') in 82 patients. Graft types included 160 reversed saphenous ve in (RSV), 95 polytetrafluoroethylene (PTFE), 84 nonreversed saphenous vein (NRSV), 41 composite grafts (PTFE plus vein) and 12 others. Resul ts show the five year patency rate for all grafts of 58 percent and li mb salvage (for limb ischemia) of 74 percent. Above knee and below kne e popliteal grafts (three year patency rates of 72 and 66 percent) per formed significantly better than distal grafts (51 percent three year patency rate, p<0.025). NRSV grafts comprised 63 ex situ (''translocat ed'') and 21 in situ grafts. No significant difference was shown betwe en these (two year patency rates of 62 and 65 percent). There was no s ignificant difference between RSV and NRSV grafts in this series, alth ough RSV tended to show big-her patency rates. Composite grafts (below knee, three year patency rate of 45 percent) had significantly lower three year patency rates than below knee RSV (79 percent, p<0.005). RS V remains the conduit of choice in this unit, with long term patency c omparable with Other published series. Use of NRSV (translocated and i n situ) allows increased use of autogenous vein with the associated bi g-her patency rates compared with prosthetic materials and is the graf t of choice if the long saphenous vein is not suitable for use in the standard reversed method. The translocated technique allows more flexi bility in the use of nonreversed vein with results comparable with the in situ technique. Composite grafts provide a useful alternative to P TFE alone for infrageniculate grafting when insufficient autogenous ve in is available.