Heparin-bonded expanded polytetrafluoroethylene grafts for infragenicular bypass in patients with critical limb ischemia: 2-year results.
OBJECTIVE
The use of prosthetic grafts in below-knee (BK) bypasses may be necessary in patients with no available autologous vein and critical limb ischemia not amenable to angioplasty. Such conduits, however, have generally yielded disappointing results.


METHODS
A new heparin-bonded expanded polytetrafluoroethylene graft (Gore-Tex Propaten Vascular Graft) designed to provide resistance to thrombosis may be associated with decreased early graft failure and increased patency. This graft was implanted in 27 limbs (26 patients; 18 men; mean age 71 years; Rutherford class 4 to 6 disease) in a BK femoropopliteal and femorodistal location, without perioperative complications and with immediate graft patency.


RESULTS
During a mean follow-up time of 24 months, 4 cases of thrombosis occurred, all at least 6 months postoperatively: 2 cases resolved after fibrinolytic treatment, 1 required surgical revision and in 1 case, amputation was required because of a delay in seeking treatment for thrombosis. Two patients died of cardiac disease during follow-up. The 2-year primary and secondary patency rates for the BK bypasses were 85% and 93%, respectively; the limb-salvage rate was 96%.


CONCLUSIONS
These results are encouraging for a prosthetic graft, especially in the light of the severity of the vascular disease in the limbs treated.
Dorrucci
V
V
Department of Vascular Surgery, Umberto I Hospital, Venice, Italy. vdorucci@ulss12.ve.it
Griselli
F
F
Petralia
G
G
Spinamano
L
L
Adornetto
R
R
D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D020099:Coated Materials, Biocompatible; D005260:Female; D006083:Graft Occlusion, Vascular; D006493:Heparin; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D013927:Thrombosis / Q000209:etiology
D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene; D006493:Heparin