title: The performance of femoropopliteal bypasses using polytetrafluoroethylene above the knee versus autogenous vein below the knee.
abstract: BACKGROUND
  Controversy exists as to the choice of conduit for the treatment of superficial femoral artery occlusive disease, particularly when a patent above-knee popliteal artery exists. Some surgeons advocate the preferential use of polytetrafluoroethylene (PTFE), whereas others favor the use of autogenous vein. This report compares our experience with above-knee femoropopliteal bypass with PTFE versus below-knee femoropopliteal bypass with autogenous vein.
  
  
  METHODS
  This study covers a 15-year period extending from 1982 to 1996 during which 1,313 arterial reconstructions were performed for superficial femoral and/or proximal popliteal arterial disease. Four hundred and thirty-eight procedures were performed to the above-knee popliteal artery using PTFE, and 875 procedures were performed to the below-knee popliteal artery using 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.
  
  
  RESULTS
  The 1-, 3-, and 5-year cumulative life table primary patency rates for the PTFE group were 74%, 56%, and 50%, respectively. The primary patency rates for the vein bypass group were 83%, 75%, and 67%, respectively (P < 0.01). The 5-year cumulative limb salvage rates were 91% and 95% for the PTFE and vein groups, respectively (P = NS).
  
  
  CONCLUSIONS
  In this series, below-knee femoropopliteal venous reconstructions have superior patency rates compared with above-knee femoropopliteal PTFE reconstructions. Venous reconstruction for femoropopliteal occlusive disease gives the optimal long-term result. Prosthetic reconstruction should be considered for patients with limited venous conduit or decreased life expectancy.
authors.affiliation: Vascular Surgery Section, Albany Medical College, New York 12208, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Woratyla
authors.forename: R C
authors.initials: RC
authors.lastname: Darling
authors.forename: B B
authors.initials: BB
authors.lastname: Chang
authors.forename: P S
authors.initials: PS
authors.lastname: Paty
authors.forename: P B
authors.initials: PB
authors.lastname: Kreienberg
authors.forename: R P
authors.initials: RP
authors.lastname: Leather
authors.forename: D M
authors.initials: DM
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007717:Knee; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011150:Popliteal Artery / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods; D014680:Veins / Q000637:transplantation*
chemical_list: D011138:Polytetrafluoroethylene