Remote arteriovenous fistula with infrapopliteal polytetrafluoroethylene bypass for critical ischemia

Between January 1985 and January 1989, 13 patients underwent femorotibial bypass using a polytetrafluoroethylene graft with a remote distal arteriovenous fistula. Indications for operation were gangrene in six patients, rest pain in five patients, and nonhealing ulcer in two patients. No patient had a usable autogenous saphenous vein. Eight patients had a previous failed femorodistal bypass. Standard femorotibial bypass was performed using a 6 mm thin-walled polytetrafluoroethylene graft. The distal remote arteriovenous fistula was done on the same artery. Warfarin was given postoperatively. Graft patency was assessed by duplex scan and digital arteriography. There was no postoperative mortality. All grafts and fistulas remained patent initially with improvement in symptoms and limb salvage. In the follow-up period there was continued graft patency in all but two patients who had a below-knee amputation. Three patients died with a patent graft. In two additional patients the graft remained patent but the fistula closed. We believe that in selected situations, the remote distal arteriovenous fistula is a potentially valuable adjunct for obligatory polytetrafluoroethylene femorotibial bypass.