Polytetrafluoroethylene use for above-knee femoropopliteal bypass in critical limb ischemia

The question of the best material for above-knee femoropopliteal bypass (polytetrafluoroethylene [PTFE] versus vein) continues to be controversial. The aim of this study was to evaluate our results of using PTFE in above knee femoropopliteal bypass and to determine the predictors which affect graft patency.

A retrospective analysis of all above knee femoropopliteal graft surgery (PTFE) carried out for limb salvage between September 1997 and October 2001 at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. All records were reviewed for risk factors, presentations, management and complications.

In a 4 year period, 52 above-knee femoropopliteal bypass grafts were performed in 49 patients. Polytetrafluoroethylene 8 mm grafts were used in all bypasses. Preoperative risk factors were diabetes 41 (80%); ischemic heart disease 17 (33%); and smoking 23 (44%). There was no operative mortality. Primary cumulative graft patency was 94% at first year, 62% at second year, 42% at third year, and 35% at fifth year. Twenty-two grafts have been occluded with re-emergence of critical ischemia in 18 patients, treated by amputation (5) and secondary reconstruction (13), of which 2 limbs required amputation later. Limb salvage was 87%. Female gender and non patent tibial vessels were the only predictors which affected graft patency.

Our results were not comparable in terms of long primary patency as those reported with autogenous vein, but comparable regarding limb salvage, early patency and ease of use. Preservation of the saphenous vein for use later encouraged us towards primary use of PTFE for above-knee femoropopliteal bypass.