PTFE-vein composite grafts for critical limb ischaemia: A valuable alternative to all-autogenous infrageniculate reconstructions

Abstract

Objectives: to analyse the long-term results of primary composite bypass grafts comparing them to PTFE grafts. Design: a retrospective observational study. Materials and methods: between 1980 and 1996, 568 primary infrageniculate bypass procedures were performed; a saphenous-vein graft was used in 428 procedures, a PTFE graft in 44 and a composite PTFE-saphenous-vein graft in 96. Thirty-six composite graphs were below the knee and the remaining 60 extended more distally. Twenty-one bypass grafts from the latter group were sequential. Mean follow-up was 45.6 months. Five-year primary and secondary patency and limb salvage rates were compared by life-table analysis. Results: cumulative 5-year primary patency for composite grafts was 58% and for saphenous-vein grafts 74%, while secondary patency rate was 75% and 82%, respectively (p < 0.05). The 5-year limb salvage rate was 80% for composite grafts and 88% for saphenous-vein grafts (p > 0.05). The primary and secondary patency and limb salvage rate for PTFE grafts was 24%, 31% and 40%, respectively. Conclusion: Composite grafts of PTFE and saphenous vein are significantly superior to PTFE graft alone and should be used in patients who lack sufficient length of saphenous vein.