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Revascularization of the leg using polytetrafluoroethylene: cumulative patency in patients with claudication and limb
Insights
Polytetrafluoroethylene (PTFE) bypass grafts show moderate patency, with femoropopliteal grafts outperforming femorotibial ones. Consider alternatives for high-risk patients due to potential occlusion requiring interventions.
Area of Science:
- Vascular Surgery
- Biomaterials Science
Background:
- Polytetrafluoroethylene (PTFE) is utilized as an arterial substitute in bypass grafting.
- Graft patency is crucial for successful revascularization in peripheral artery disease.
Purpose of the Study:
- To evaluate the long-term patency rates of PTFE bypass grafts in the leg.
- To identify factors influencing PTFE graft patency and outcomes.
Main Methods:
- Retrospective analysis of 196 PTFE bypass grafts (113 femoropopliteal, 83 femorotibial/femoroperoneal).
- Life-table method used to calculate cumulative patency rates at 1, 2, and 3 years.
- Analysis of indications (claudication vs. limb salvage) and patient factors (distal runoff, prior graft failure).
Main Results:
- Femoropopliteal PTFE grafts had 1, 2, and 3-year patency rates of 66%, 53%, and 49%, respectively.
- Femorotibial/femoroperoneal PTFE grafts showed lower patency rates: 48% (1 year), 44% (2 years), and 36% (3 years).
- Best outcomes were associated with femoropopliteal grafts for claudication with good runoff and no prior graft failure; worst outcomes in distal bypasses for limb salvage and prior graft failure.
Conclusions:
- PTFE grafts demonstrate acceptable, though not ideal, patency rates as arterial substitutes when saphenous veins are unavailable.
- Graft occlusion risk is higher in specific patient groups, necessitating consideration of alternative revascularization strategies.
- A significant proportion of PTFE grafts will require thrombectomy or revision to maintain patency.
Abstract:
Of 196 polytetrafluoroethylene bypass grafts in the leg, 113 were placed in the femoropopliteal and 83 in the femorotibial or femoroperoneal position. Claudication was the indication for 31 percent of the grafts, and 67 percent were done for limb salvage. Cumulative patency rates calculated by the life-table method for the femoropopliteal grafts were 66 percent at 1 year, 53 percent at 2 years, and 49 percent at 3 years. Corresponding patency rates for the femorotibial or peroneal grafts were 48, 44, and 36 percent, respectively. An analysis of factors influencing graft patency indicated that the best results were obtained with femoropopliteal grafts done for claudication in the presence of good distal runoff and grafts placed in limbs without previously failed grafts. Graft occlusion was most likely in distal bypasses for limb salvage and limbs with previously failed grafts. It is concluded that alternatives to PTFE bypass should be considered in those patients at greatest risk for graft occlusion. In patients who lack a satisfactory saphenous vein but who must have a bypass graft, polytetrafluoroethylene is an acceptable arterial substitute; however, thrombectomy or revision will be required to maintain patency in a high proportion of cases.