Expanded polytetrafluoroethylene grafts for severe lower limb ischaemia

Area of Science:

• Vascular Surgery
• Biomaterials Science

Background:

• Severe lower extremity ischemia poses a significant challenge, often necessitating amputation.
• Saphenous vein availability is a limiting factor in traditional bypass procedures.
• Elderly and infirm patients present unique challenges in surgical decision-making.

Purpose of the Study:

• To report three years of experience using expanded polytetrafluoroethylene (ePTFE) grafts for femoropopliteal bypass in severe lower extremity ischemia.
• To evaluate the efficacy and outcomes of ePTFE grafts in limb salvage and patient selection.
• To assess graft patency rates and identify factors influencing outcomes.

Main Methods:

• Retrospective analysis of 44 femoropopliteal bypasses using ePTFE grafts.
• Grafts were utilized when saphenous vein was unavailable or to reduce operative time in infirm patients.
• Patient demographics, comorbidities (ischemic heart disease, diabetes), and follow-up data were collected.

Main Results:

• Overall life-table cumulative patency was 59% at 6 months, 52% at 1 year, and 40% at 2 years.
• No significant correlation found between patency and run-off, diabetes, or smoking.
• Above-knee grafts showed a trend towards better patency than below-knee grafts.
• Graft occlusion led to 12 amputations, 3 reconstructions, and 1 death; 9 other deaths occurred from unrelated causes.

Conclusions:

• ePTFE grafts are a valuable prosthetic option for femoropopliteal bypass in severe lower extremity ischemia, especially in elderly, unfit patients.
• These grafts can facilitate limb salvage in cases where autologous vein is not feasible.
• Continued evaluation of ePTFE grafts in selected patient populations is warranted to optimize outcomes.