A prospective randomized trial comparing vein with polytetrafluoroethylenein above-knee femoropopliteal bypass grafting

Objective: Despite many clinical studies, there is still uncertainty as to whether venous material is superior to polytetrafluoroethylene for femoropo pliteal reconstruction proximal to the knee joint. Supported by early satis factory results with thin-walled, stretched polytetrafluoroethylene for sup rageniculate bypass grafts, a prospectively randomized clinical trial was d esigned to evaluate the effectiveness of reversed saphenous vein in compari son with that of polytetrafluoroethylene in above-knee arterial reconstruct ion. Methods: In a a-year period, 151 above-knee femoropopliteal bypass graft op erations were performed in 136 patients (77 male, 59 female). The indicatio n for operation was severe claudication in 120 cases, rest pain in 20 cases , and ulceration in 11 cases. For the bypass graft, a reversed saphenous ve in was used in each of 75 cases, and a polytetrafluoroethylene prosthesis w as used in each of 76 cases. Preoperative risk factors were diabetes (24%), a history of myocardial infarction (23%), and current status with respect to smoking (74%). There was no hospital mortality; 5% of patients had minor postoperative complications. Results: After 2 years, the primary patency was 83% for saphenous vein and 67% for polytetrafluoroethylene (P = .065); the secondary patency was 83% f or saphenous vein and 77% for polytetrafluoroethylene (P = .298). During a follow up period of 2 years, we found no statistically significant differen ce in primary and secondary patency between saphenous vein and polytetraflu oroethylene. We found no predictive factor for occlusion of either bypass g raft. Conclusion: The use of polytetrafluoroethylene above the knee is a reasonab le alternative in femoropopliteal bypass grafting that is associated with a cceptable short-term patency rates. (J Vasc Surg 2000;32:278-83.).