Composite sequential bypasses to the ankle and beyond for limb salvage

Composite grafts of polytetrafluoroethylene (PTFE) and saphenous vein were used for sequential bypasses to the ankle and foot in 35 men and 19 women (mean age 66.5 years). Presenting symptoms were rest pain (25), digital gangrene (19), and ischemic ulcer (10). Thirty-one tibial and 23 pedal bypasses were done and were followed up to 48 months (mean 26.4 months). The ankle pressure index rose from 0.31 +/- 0.11 preoperatively to 0.77 +/- 0.21 postoperatively. Mean graft flows were 34.8 ml/min. Composite sequential grafts took 51 minutes longer to perform than femoral-tibial vein grafts. Patency rates by the life-table method were 81.4% at 2 years and 72.4% at 4 years. Graft failures after the first 10 weeks usually led to amputation. Use of PTFE as an inflow conduit permits otherwise inadequate lengths of saphenous vein to be used for anastomosis to delicate distal vessels and takes advantage of the vein's ability to tolerate low flows. Our experience suggests that the excellent patency rates make sequential bypasses a reasonable option for limb salvage.