LOWER-EXTREMITY BYPASS FOR CRITICAL ISCHEMIA USING SYNTHETIC CONDUIT AND ADJUVANT VEIN CUFF

The use of an interposition cuff of vein placed at the distal anastomo sis between synthetic bypass conduit and outflow vessel has been advoc ated to improve patency of lower extremity bypass grafts. Over a three -year period we have performed 43 such bypass procedures: to the above knee popliteal artery (n = 3), below knee popliteal (n = 13), and inf rapopliteal arteries (n = 27). There were 20 females and 23 males havi ng a mean age of 70 years (48-84 years). Fifteen patients were hyperte nsive, 15 were diabetic, and 25 had a history of tobacco use. All case s required limb salvage for rest pain (n = 25), gangrene (n = 10), or ulceration (n = 8) in the absence of suitable autologous vein, Ninetee n operations followed a previous failed bypass. Patients were reviewed at six-month intervals. The operative mortality was 8% and two-year p rimary and secondary patency were 40% and 55%, respectively. Cumulativ e patency rates were better for first-time grafting procedures than fo r patients who had undergone previous attempts at limb salvage (60% ve rsus 22%), Two-year limb salvage was 60%, During the same time period, two-year primary and secondary patency rates were 54% and 67%, respec tively for autogenous vein. Although the numbers are small these resul ts support the use of an adjuvant vein cuff when employing synthetic g rafts. A prospective study of vein versus synthetic graft plus cuff sh ould be undertaken.