PROSTHETIC BYPASS WITH A DISTAL VEIN PATCH FOR LIMB SALVAGE

BACKGROUND: Certain patients require tibial bypass for limb salvage wi thout adequate Vein available as the conduit. Polytetrafluoroethylene (PTFE) bypasses result in decreased patency prompting the addition of venous tissue at the distal anastomosis as cuffs, collars, and boots. We assessed feasibility and graft patency of a distal vein patch (DVP) interposed between PTFE and the tibial artery. METHODS: Between 7/93 and 7/96, 148 tibial bypasses were performed with 25 (17%) using PTFE/ DVP as the conduit. Patient demographics (n = 24) were 11 males and 13 females, mean age of 67, diabetes (n = 15, 57%), renal failure (n = 8 , 31%), and excessive cardiac risk (n = 20, 83%). All patients had lim b-threatening ischemia with rest pain in 14 (58%) and gangrene/nonheal ing ulcer in 10 (42%). Lack of vein was due to previous failed bypass (15,63%), cardiac surgery (5,21%), and unsuitable vein (4,21%). Patien ts were discharged on coumadin with follow-up at 1 month, 6 months, an d annually. RESULTS: PTFE/DVP bypasses originated from the CFA (13,48% ), the SFA (3,11%) and the external iliac artery due to previous groin dissection (9,41%). Recipient arteries included anterior tibial (7), posterior tibial (8), and peroneal (10). Follow-up ranged from 1 to 36 months. Cumulative graft patency at 6 months and 3 years was 91% and 78%, respectively, by life table analysis. Limb salvage was 91%. CONCL USION: These early data indicate that tibial bypass with PTFE/DVP as t he conduit results in acceptable patency and limb salvage. in the pati ent without adequate vein, PTFE bypasses to tibial arteries for limb s alvage may be improved with a distal vein patch. (C) 1997 by Excerpta Medica, Inc.