Consequences of failure of femoro-popliteal grafts for claudication

In order to evaluate the repercussions of failure of femoro-popliteal reconstruction undertaken for claudication the records of 219 patients with 251 femoro-popliteal conduits were reviewed. Autogenous Saphenous Vein graft (SV) was used in 109 limbs, Polytetrafluoroethylene graft (PTFE) in 101 and human umbilical vein graft (HUV) in 41. Primary patency rates after 3 years of follow-up of 72% for all grafts, 81% for SV-grafts, 84% for HUV-grafts and 59% for PTFE-grafts were calculated: the difference between SV-grafts and PTFE-grafts is statistically significant (P = 0.0047). Accordingly the authors advise against the use of PTFE-grafts in femoro-popliteal reconstruction. Including reinterventions secondary patency rates after 3 years of follow-up of 88% for all grafts, 86% for SV-grafts, 94% for HUV-grafts and 79% for PTFE-grafts were found: these differences were statistically not significant. Further analysis of the occluded grafts showed that in case of graft failure one or two re-operations are justified. The 12-months patency rate of reinterventions was 58%. Considering the life-expectancy and the natural history for the next five years of a patient with claudication the authors have become conservative towards femoro-popliteal reconstruction for claudication.