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Distal polytetrafluoroethylene bypasses in patients older than 75 years
G Illuminati1, A Bertagni, F G Caliò
1Department of Surgical Sciences and Applied Technologies, University of Rome La Sapienza, Italy.
Hypothesis:
Polytetrafluoroethylene (PTFE) alone is justified for infrapopliteal arterial grafting in elderly patients with critical ischemia of the lower limbs who lack a suitable, autogenous saphenous vein.
Design:
A consecutive sample clinical study with a mean follow-up of 16 months.
Setting:
The surgical department of an academic tertiary care center and an affiliated secondary care center.
Patients:
Thirty-one patients older than 75 years with critical ischemia of the lower limbs received 34 PTFE bypass grafts to the infrapopliteal arteries: 12 patients to the anterior tibial, 8 to the peroneal, 8 to the posterior tibial, and 2 to the dorsalis pedis artery.
Main Outcome Measures:
Cumulative survival, primary graft patency, and limb salvage rates expressed by standard life-table analysis.
Results:
Operative mortality rate was 3%. Cumulative survival rate was 80% at 2 years (SE, 9.2%) and 43% at 3 years (SE, 11.4%). Cumulative primary patency rate was 67% at 2 years (SE 9.1%), and 61% at 3 years (SE, 12.7%). Cumulative limb salvage rate was 77% at 2 years (SE, 8.7%) and 70% at 3 years (SE, 12.8%).
Conclusion:
Polytetrafluoroethylene alone is justified as graft material for infrapopliteal bypass grafts in elderly patients with critical ischemia of the lower limbs and without a suitable autogenous saphenous vein.