Prospective controlled study of polytetrafluoroethylene versus saphenous vein in claudicant patients with bilateral above knee femoropopliteal bypasses

Background. Although several studies have compared the patency rates of pol ytetrafluoroethylene (PTFE) and saphenous vein grafts (SVG) for the above k nee location, none have compared the 2 grafts when Implanted in the same pa tient with claudication who needs bilateral above knee femoropopliteal bypa sses Methods. Forty-three patients (86 limbs) with bilateral disabling claudicat ion who had superficial formal artery occlusion and above knee reconstituti on with 2- to 3-vessel runoff were analyzed. Patients were treated on one s ide with PTFE and on the other side with SVG. They were sequentially assign ed to PTFE-SVG alternating with SVG-PTFE. All patients were followed using duplex ultrasound and ankle/brachial indexes at I month and every 6 months thereafter . Results. The perioperative complication rates were 5% So PTFE and 12% for S VG, There was no operative death or perioperative amputation for either pro cedure. The Kaplan-Meier estimate of primary, assisted primary and secondar y patency rates at 72 months were 68%, 68%, and 77% for PTFE and 76%, 83%, and 85% Sor SVG. There were no statistically significant differences betwee n primary and secondary patency rates for both grafts; however the assisted primary patency rates were higher SVG (P < .05). The nude limb, salvage ra te at 72 months was 98% Sol PTFE and 98% for SVG There were no risk factors identified that had an impact on graft patency. Conclusions. PTFE and SVG for above knee bypasses have comparable patency a nd limb salvage rates in claudicant patients with bilateral superficial fem oral artery occlusion and 2- to 3-vessel runoff. This may justify the use o f PTFE for above knee locations in these selected patients.