The long-term value of composite grafts for limb salvage

We determined the long-term efficacy of composite grafts for limb salvage when autogenous vein grafts were not available.

After arterial bypass, the 8-year primary and secondary patency, limb salvage, and mortality rates were compared by life-table analysis. One hundred twenty-five patients had 130 composite grafts for 27 femoropopliteal bypasses, 48 femorotibial bypasses, and 55 sequential femoropopliteotibial bypasses. Three hundred forty patients had autogenous vein grafts for 247 femoropopliteal bypasses and 114 femorotibial bypasses. Seventy-two patients had 82 femoropopliteal prosthetic grafts.

Eight-year primary and secondary patency rates were 56% and 62% for femoropopliteal procedures with composite grafts, respectively, and 53% and 59% for autogenous vein grafts, respectively. The secondary patency rate for polytetrafluoroethylene grafts was 35% and was less (p < 0.05) than the rate for the vein grafts. Secondary patency rates for femorotibial procedures were 66% for the vein grafts, 56% for single outflow composite grafts, and 52% for dual outflow composite grafts. Limb salvage rates for femoropopliteal procedures were 73% for composite grafts, 63% for polytetrafluoroethylene, and 82% for vein grafts, and for femorotibial procedures were 53% for single outflow composite grafts, 65% for dual outflow composite grafts, and 86% for vein grafts.

Composite grafts achieve long-term preservation of ischemic limbs in patients who are facing limb loss because of poor run-off and have insufficient autogenous vein for a graft.