PTFE-vein composite grafts for critical limb ischaemia: a valuable alternative to all-autogenous infrageniculate reconstructions

Objectives: to analyse the long-term results of primary composite bypass gr afts comparing them to PTFE and vein grafts. Design: a retrospective observational study. Materials and methods: between 1980 and 1996, 568 primary infrageniculate b ypass procedures were performed; a saphenous-vein graft was used in 428 pro cedures, a PTFE graft in 44 and a composite PTFE-saphenous-vein graft in 96 . Thirty-six composite grafts were below the knee and the remaining 60 exte nded more distally. Twenty-one bypass grafts from the latter group were seq uential. Mean follow-up was 45.6 months. Five-year primary and secondary pa tency and limb salvage rates were compared by life-table analysis. Results: cumulative 5-year primary patency for composite grafts was 58% and for saphenous-vein grafts 74%, while secondary patency rate was 75% and 82 %, respectively (p<0.05). The 5-year limb salvage late was 80% for composit e grafts and 88% for saphenous-vein grafts (p>0.05). The primary and second ary patency and limb salvage rate for PTFE grafts was 24%, 31% and 40%, res pectively. Conclusion: Composite grafts of PTFE and saphenous vein are significantly s uperior to PTFE graft alone and should be used in patients who lack suffici ent length of saphenous vein.