A paper for debate: vein versus PTFE for critical limb ischaemia--an unfair comparison?
BACKGROUND
There is a widely held view that vein grafts for infrainguinal arterial reconstruction perform much better than prosthetic conduits, the best of which seems to be PTFE. Many randomised studies have been conducted which confirm this opinion, but is the difference as large as it is thought to be? One interesting feature of published trials is that the results for obligatory PTFE (when no vein is available) were much worse than the results for randomised PTFE grafts. The only way to explain this is that these groups of patients were not similar, and there are probably other factors which contribute to the difference in results when vein and PTFE grafts are compared.


METHODS
A consecutive series of 109 femoro-infrapopliteal grafts undertaken for critical limb ischaemia was analysed to see the difference between vein and PTFE with vein cuff grafts.


RESULTS
Vein grafts were superior to PTFE grafts when the whole cohort was included (p = 0.0038); however, there was no significant difference when the patients were stratified for inflow and runoff status.


CONCLUSIONS
The difference between vein and PTFE has probably been exaggerated in the past, due to differences in risk factors and in the extent of arterial disease between the two groups of patients. The advantage of vein becomes more significant with time.
Panayiotopoulos
Y P
YP
Department of Surgery, Guy's Hospital, London, U.K.
Taylor
P R
PR
D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D015331:Cohort Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D011138:Polytetrafluoroethylene; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*
D011138:Polytetrafluoroethylene