The use of composite grafts in femorocrural bypasses performed for limb salvage: A review of 108 consecutive cases and comparison with 57 in situ saphenous vein bypasses

Abstract

We retrospectively reviewed the results of 108 consecutive femorocrural bypasses performed with prosthetic/autogenous composite graft material and compared these with the results of 57 crural bypasses using greater saphenous vein by the in situ technique. Indication for operation in all cases was the salvage of an otherwise imminently threatened limb. Polytetrafluoroethylene-composite grafts (n = 87) and human umbilical vein-composite grafts (n = 21) were placed only in patients lacking suitable autogenous material for in-line reconstruction. Patient groups were similar with respect to mean age, prevalence of arterial disease risk factors, quality of the distal runoff, and location of the distal anastomosis. Cumulative patency rates at 1 year by life-table analysis were 81.9%, 34.6%, and 12.1% for the in situ, polytetrafluoroethylene-composite and human umbilical vein-composite groups, respectively. At 2 years these were 63.9%, 29.9%, and 6.0%, respectively (p less than 0.025). Cumulative limb salvage at 1 year was 70.6%, 62.3%, and 32.7%, respectively. Wound-related complications occurred in 52.4% of human umbilical vein-composite, 38.6% of in situ, and 18.3% of polytetrafluoroethylene-composite bypasses (p less than 0.05). On the basis of these results, we conclude that femorocrural bypass with polytetrafluoroethylene-composite graft is an acceptable form of distal reconstruction for limb salvage in patients lacking sufficient lengths of autogenous vein. We no longer use human umbilical vein for composite construction.

Tibial bypass grafting for limb salvage with ringed polytetrafluoroethylene prostheses: Results of primary and secondary procedures

“…One of the most important determinants for early outcome of infrainguinal reconstructions is the outflow resistance as judged by the angiographic runoff status. 2,4,8,9 Proper selection of patients and exclusion from operative consideration of cases with poor runoff will result in a low early failure rate.…”

Results of bypasses to the anterior tibial artery through the interosseous membrane

“…Because we were dissatisfied with externally tunneled bypasses to the anterior tibial artery, in terms of skin complications, and empirically thought that the anatomic route would enable the conduit to assume a more harmonious adaptation to the knee joint when crossing through the interosseous membrane, we began to tunnel grafts directed to the anterior tibial artery in an anatomic fashion. Overall patency of this series is 50% at 3 years, with a limb salvage rate of 70% for the same interval: this is within the overall standard results of distal revascularization [1,2,4,5,10,11].…”

“…The best patency rates are achieved with autologous saphenous vein as a conduit, no matter whether inversed or "in situ" [2,5,11]; nevertheless, when fully autologous vein material is lacking acceptably good patency rates can be achieved with composite grafts as well [4]. Information about wound complications and length of hospitalization are somewhat lacking in the literature.…”

Results of Infrainguinal Bypass with a Composite Graft Combining Polytetrafluoroethylene and Vein Graft in Absence of Appropriate Saphenous Vein Graft

“…Second, only an autogenous vein of good quality with a large diameter must be used. Prior studies have reported unfavorable outcomes of composite prosthetic-autogenous grafts [11,23,24]; however, these studies have a possibility of selection bias, and the details of the procedures using composite grafts were not well described. Third, the operation must be performed in a planned manner.…”