Axillofemoral bypass grafts using polytetrafluoroethylene

More liberal indications for axillofemoral bypass grafts have recently been advocated if long-term patency were comparable to aortic bypass procedures. A clinical trial of polytetrafluoroethylene (PTFE) axillofemoral grafts was instituted in an attempt to maximize graft patency. The theoretic advantages of this material were: (1) a more rigid tube graft, (2) a surface impermeable to blood, (3) a thin pseudointima, and (4) better tissue incorporation. During the last two years, 29 axillofemoral bypass grafts of PTFE have been inserted. Four have failed, one of them now functioning after successful thrombectomization. The cumulative patency rate (life table) for 21 months is 79% "patent" grafts and 84% "functioning" grafts. Six patients have died (21%). There have been three complications, all involving avulsion of the graft at the proximal or distal anastomosis. There have been no infections. Our early results support broadened indications for axillofemoral grafts, since patency rates are comparable to those for aortoiliac/femoral grafts in many series. The characteristics of PTFE appear to be largely responsible for the early success of these grafts, with minimized blood loss and graft hematomas. Great care is required in sizing this rigid tube because tension may produce graft avulsion.