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Preferential use of ePTFE for above-knee femoropopliteal bypass grafts

  • Original Articles
  • Published:
Annals of Vascular Surgery

Abstract

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.

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References

  1. KUNLIN J. Le traitment de l'arterite obliterante par la greffe veneuse.Arch Mal Coeur 1949;42:371–379.

    Google Scholar 

  2. SZILAGYI DE, HAGEMAN JH, SMITH RF, et al. Autogenous vein grafting in femoropopliteal atherosclerosis: the limits of its effectiveness.Surgery 1979;86:836–851.

    PubMed  Google Scholar 

  3. TAYLOR LM Jr, PHINNEY ES, PORTER JM. Present status of reversed vein bypass for lower extremity revascularization.J Vasc Surg 1986;3:288–297.

    Article  PubMed  Google Scholar 

  4. CHRISTENSON JT, BROOME A, NORGREN L, et al. Revascularization of popliteal and below-knee arteries with polytetrafluoroethylene.Surgery 1985;97:141–149.

    PubMed  Google Scholar 

  5. GUPTA SK, VEITH FJ. Three year experience with expanded polytetrafluoroethylene arterial grafts for limb salvage.Am J Surg 1980;140:214–217.

    Article  PubMed  Google Scholar 

  6. BERGAN JJ, VEITH FJ, BERNHARD VM, et al. Randomization of autogenous vein and polytetrafluoroethylene grafts in femoral-distal reconstruction.Surgery 1982;92:921–930.

    PubMed  Google Scholar 

  7. TILANUS HW, OBERTOP H, VAN URK H. Saphenous vein or PTFE for femoropopliteal bypass. A prospective randomized trial.Ann Surg 1985;202:780–782.

    PubMed  Google Scholar 

  8. CRANLEY JJ, HAFNER CD. Newer prosthetic material compared with autogenous saphenous vein for occlusive arterial disease of the lower extremity.Surgery 1981;89:2–7.

    PubMed  Google Scholar 

  9. WEISEL RD, JOHNSTON KW, BAIRD RJ, et al. Comparison of conduits for leg revascularization.Surgery 1981;89:8–15.

    PubMed  Google Scholar 

  10. JULIAN TB, LOUBEAU J-M, STREMPLE JF. Polytetrafluoroethylene or saphenous vein as a femoropopliteal bypass graft?J Surg Res 1982;32:1–6.

    Article  PubMed  Google Scholar 

  11. HURWITZ RL, JOHNSON JM, HUFNAGEL CE. Femoropopliteal bypass using externally supported polytetrafluoroethylene grafts.Am J Surg 1985;150:574–576.

    Article  PubMed  Google Scholar 

  12. BENNION RS, WILLIAMS RA, STABILE BE, et al. Patency of autogenous saphenous vein versus polytetrafluoroethylene grafts in femoropopliteal bypass for advanced ischemia of the extremity.Surg Gynecol Obstet 1985;160:239–242.

    PubMed  Google Scholar 

  13. HAIMOV H, GIRON F, JACOBSON JH II. The expanded polytetrafluoroethylene graft. Three year's experience with 362 grafts.Arch Surg 1979;114:673–677.

    PubMed  Google Scholar 

  14. SIMONE ST Jr, DUBNER B, SAFI AR, et al. Comparative review of early and intermediate patency rates of polytetrafluoroethylene and autogenous saphenous vein grafts for lower extremity ischemia.Surgery 1981;90:991–998.

    PubMed  Google Scholar 

  15. QUINONES-BALDRICH WJ, MARTIN-PARADERO V, BAKER JD, et al. PTFE grafts as the arterial substitute of first choice in femoropopliteal revascularization.Arch Surg 1984;119:1238–1243.

    PubMed  Google Scholar 

  16. VEITH FJ, GUPTA SK, ASCER E, et al. Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions.J Vasc Surg 1986;3:104–114.

    Article  PubMed  Google Scholar 

  17. CORSON JD, BREWSTER DC, LASALLE AJ, et al. Comparative analysis of vein and prosthetic bypass grafts to the isolated popliteal artery.Surgery 1982;91:448–451.

    PubMed  Google Scholar 

  18. BREWSTER DC, LASALLE AJ, ROBISON JG, et al. Factors affecting patency of femoropopliteal bypass grafts.Surg Gynecol Obstet 1983;157:437–442.

    PubMed  Google Scholar 

  19. ROSEN RC, JOHNSON WC, BUSH HL Jr, et al. Staged infrainguinal revascularization: initial prosthetic above-knee bypass followed by a distal vein bypass for recurrent ischemia.Am J Surg 1986;152:224–230.

    Article  PubMed  Google Scholar 

  20. STERPETTI AV, SCHULTZ RD, FELDHAUS RJ, et al. Seven-year experience with polytetrafluoroethylene as above-knee femoro-popliteal bypass graft. Is it worthwhile to preserve the autologous saphenous vein?J Vasc Surg 1985;2:907–912.

    Article  PubMed  Google Scholar 

  21. TAYLOR LM, EDWARDS JM, BRANT B, et al. Autogenous reversed vein bypass for lower extremity ischemia in patients with absent or inadequate greater saphenous vein.Am J Surg 1987;153:505–510.

    Article  PubMed  Google Scholar 

  22. KENT KC, WHITTEMORE AD, MANNICK JA. Short-term and mid-term results of an all-autogenous tissue policy for infraiguinal reconstruction.J Vasc Surg, 1989;9:107–114.

    Article  PubMed  Google Scholar 

  23. RUTHERFORD RB, FLANIGAN DP, GUPTA SK, et al. Suggested standards for reports dealing with lower extremity ischemia.J Vasc Surg 1986;4:80–94.

    Article  PubMed  Google Scholar 

  24. KEMPCZINSKI RF. Segmental volume plethysmography in the diagnosis of lower extremity arterial occlusive disease.J Cardiovasc Surg 1982;23:125–129.

    Google Scholar 

  25. PETO R, PIKE MC, ARMITAGE P, et al. Design and analysis of randomized trials required prolonged observations of each patient II. Analysis and examples.Br J Cancer 1977;35:1.

    PubMed  Google Scholar 

  26. RAFFERTY TD, AVELLONE JC, FARRELL CJ, et al. A metropolitan experience with infrainguinal revascularization.J Vasc Surg 1987;6:365–371.

    Article  PubMed  Google Scholar 

  27. RUTHERFORD RB, JONES DN, BERGENTZ S-E, et al. Factors affecting the patency of infrainguinal bypass.J Vasc Surg 1988;8:236–246.

    Article  PubMed  Google Scholar 

  28. QUIÑONES-BALDRICH WJ, BUSUTTIL RW, BAKER JD, et al. Is the preferential use of polytetrafluoroethylene grafts for femoropopliteal bypass justified?J Vasc Surg 1988;8:219–228.

    Article  PubMed  Google Scholar 

  29. SHULMAN ML, BADHEY MR. Late results and angiographic evaluation of arm veins as long bypass grafts.Surgery 1982;92:1032–1041.

    PubMed  Google Scholar 

  30. BREWSTER DC, CHARLESWORTH PM, MONAHAN JE, et al. Isolated popliteal segment vs tibial bypass. Comparison of hemodynamic and clinical results.Arch Surg 1984;119:775–779.

    PubMed  Google Scholar 

  31. EVANS LE, WEBSTER MW, BROOKS DH, et al. Expanded polytetrafluoroethylene femoropopliteal grafts: forty-eight month follow-up.Surgery 1981;89:16–22.

    PubMed  Google Scholar 

  32. McCAULEY CE, STEED DL, WEBSTER MW. Seven-year follow-up of expanded polytetrafluoroethylene (PTFE) femoropopliteal bypass grafts.Ann Surg 1984;199:57–60.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. From the Department of Surgery, Division of Vascular Surgery and the Department of Environmental Health, Division of Biostatistics, University of Cincinnati Medical Center, Cincinnati, Ohio

    Robert B. Patterson MD, Richard J. Fowl MD, Richard F. Kempczinski MD, Robert Gewirtz MD & Rakesh Shukla PhD

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  1. Robert B. Patterson MD
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  2. Richard J. Fowl MD
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  3. Richard F. Kempczinski MD
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  4. Robert Gewirtz MD
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  5. Rakesh Shukla PhD
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Patterson, R.B., Fowl, R.J., Kempczinski, R.F. et al. Preferential use of ePTFE for above-knee femoropopliteal bypass grafts. Annals of Vascular Surgery 4, 338–343 (1990). https://doi.org/10.1007/BF02000496

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