Preliminary clinical experience with polyurethane vascular prostheses in femoro-popliteal reconstruction

Following promising results in animals, implantation of polyurethane vascular prostheses for femoral reconstruction was performed in 15 patients over a 10-month period. This prospective study was carried out to evaluate the patency, limb salvage and complications associated with this type of small diameter conduit for arterial occlusive diseases. The indications for surgery included acute and chronic ischaemia, non-healing ulceration or gangrene. There were five early occlusions, which resulted in a 1-month primary patency rate of 66% and a secondary patency rate of 80%. The mean limb salvage rate at 1 month was 80% and is 66% at the present time. Infection occurred in one patient following multiple attempts at graft thrombectomy. There were no statistically significant differences in patency rates between proximal and distal popliteal graft anastomoses. Two critical phases of healing were identified where the graft was prone to flow deterioration; at 4-6 weeks and at 4-6 months. It is concluded that although this type of graft has many interesting features, e.g. the presence of endothelial cells under poor haemodynamic conditions, excellent graft-host healing and good resistance at the suture site, further investigations on protein absorption and complement activation as well as intensive structural testing are required before further recommendations can be made.