Preferential use of EPTFE for above-knee femoropopliteal bypass grafts.
We have used polytetrafluoroethylene preferentially for bypasses to the above-knee popliteal artery since 1979. Since this approach has recently been challenged, we reviewed our experience with 138 grafts in 128 patients. The majority (74%) of patients were male with a mean age of 63.2 years. Risk factors included: smoking (85%), hypertension (55%), diabetes mellitus (45%), and coronary artery disease (41%). The indications for operation were disabling claudication (18%), rest pain (42%), gangrene/tissue loss (33%), and miscellaneous (7%). Perioperative (30 day) mortality was 3% and morbidity (excluding amputation or graft failure) was 5%. Patients were followed for up to eight years with a mean follow-up of 22.1 months. Grafts which remained patent, but did not prevent major amputation, were classified as "failed". Primary patency was 75% at one year and 54% at five years. Limb salvage was 88% at one year and 70% at five years. Risk factors, indication for operation and arteriographic runoff had no statistically significant impact on short- or long-term patency. However, bypass grafts to isolated popliteal segments had a significantly (p = 0.025) increased perioperative failure rate compared to all other grafts. Our data support the continued use of polytetrafluoroethylene for above-knee femoropopliteal bypass except perhaps in patients who require grafting to an isolated popliteal segment where higher early failure rates were seen.
Patterson
R B
RB
Department of Surgery, University of Cincinnati Medical Center, Ohio 45267-0558.
Fowl
R J
RJ
Kempczinski
R F
RF
Gewirtz
R
R
Shukla
R
R
D000368:Aged; D000714:Anastomosis, Surgical; D001672:Biocompatible Materials; D001807:Blood Vessel Prosthesis; D005069:Evaluation Studies as Topic; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011150:Popliteal Artery / Q000601:surgery*; D012307:Risk Factors; D014654:Vascular Patency
D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene