THE PERFORMANCE OF FEMOROPOPLITEAL BYPASSES USING POLYTETRAFLUOROETHYLENE ABOVE THE KNEE VERSUS AUTOGENOUS VEIN BELOW-THE-KNEE

BACKGROUND: Controversy exists as to the choice of conduit for the tre atment of superficial femoral artery occlusive disease, particularly w hen a patent above-knee popliteal artery exists. Some surgeons advocat e the preferential use of polytetrafluoroethylene (PTFE), whereas othe rs favor the use of autogenous vein. This report compares our experien ce with above-knee femoropopliteal bypass with PTFE versus below-knee femoropopliteal bypass with autogenous vein. METHODS: This study cover s a 15-year period extending from 1982 to 1996 during which 1,313 arte rial reconstructions were performed for superficial femoral and/or pro ximal popliteal arterial disease. Four hundred and thirty-eight proced ures were performed to the above-knee popliteal artery using PTFE, and 875 procedures were performed to the below-knee popliteal artery usin g autogenous vein. The indication for surgery was limb salvage in 77% of patients in the PTFE group and 88% of patients in the vein group. R ESULTS: The 1-, 3-, and 5-year cumulative life table primary patency r ates for the PTFE group were 74%, 56%, and 50%, respectively. The prim ary patency rates for the vein bypass group were 83%, 75%, and 67%, re spectively (P < 0.01). The 5-year cumulative limb salvage rates were 9 1% and 95% for the PTFE and vein groups, respectively (P = NS). CONCLU SIONS: In this series, below-knee femoropopliteal venous reconstructio ns have superior patency rates compared with above-knee femoropoplitea l PTFE reconstructions. Venous reconstruction for femoropopliteal occl usive disease gives the optimal long-term result. Prosthetic reconstru ction should be considered for patients with limited venous conduit or decreased life expectancy. (C) 1997 by Excerpta Medica, Inc.