PATENCY OF INFRAINGUINAL POLYTETRAFLUOROETHYLENE BYPASS GRAFTS WITH DISTAL INTERPOSITION VEIN CUFFS

Polytetrafluoroethylene (PTFE) prosthetic bypasses in the lower extrem ity have poor patency rates, particularly in limb salvage cases. Paten cy and limb salvage rates of PTFE bypasses supplemented by distal inte rposition vein cuffs were assessed in patients requiring revasculariza tion for critical limb ischemia, in the absence of a suitable autologo us saphenous vein. Between October 1993 and April 1996, 163 patients u nderwent 185 infrainguinal bypasses. Forty-three limbs in 42 patients (12 women, 30 men; mean age 67 years) did not have a suitable autologo us saphenous vein (24%) and had femoropopliteal (20) and infrapoplitea l (23) bypasses performed. Patients were examined prospectively at 3-m onth intervals during the first year and at 6-month intervals thereaft er to determine graft patency and limb salvage, Postoperative anticoag ulation with warfarin was used in 26 patients, Indications for operati on included limb salvage in 41 extremities (21 rest pain/ulceration or gangrene, 20 rest pain alone), and disabling claudication in two. Pat ients were followed clinically for 2-30 months (mean 10 months). Cumul ative 2-year life-table patencies for all grafts, femoropopliteal and infrapopliteal bypasses were 64%, 75% and 62%, respectively, Previous primary patencies at the authors' institution for PTFE bypasses withou t vein cuffs were 35%, 46% and 12% for the same categories, Cumulative life-table limb salvage for all PTFE/vein cuff bypasses in the presen t series was 76% compared with 37% in previous PTFE bypasses without v ein cuffs, Adjunctive use of distal interposition vein cuffs improves prosthetic graft patency, while producing satisfactory limb salvage. P ostoperative anticoagulation did not influence graft patency, PTFE/vei n cuff for lower-extremity revascularization shows good 2-year patency and is an acceptable alternate conduit in patients with critical limb ischemia when autologous saphenous vein is absent. (C) 1998 The Inter national Society for Cardiovascular Surgery.