Femoral-infrapopliteal bypass with prosthetic grafts

Background. Patients who require prosthetic infrapopliteal of the lower extremity have historically had dismal long-term results. This study examined the outcome of patients undergoing femoral-distal arterial bypass with expanded polytetrafluoroethylene (ePTFE) grafts. Methods. Femoral to infrapopliteal artery bypasses with ePTFE performed between 1990 and 1997 were reviewed. Graft patency, limb salvage, and survival rates were calculated by actuarial analysis. Different anastomotic adjuncts (direct end-to-side anastomosis, vein patch anastomosis, and arteriove-nous fistula [AVF] anastomosis) were compared with the log-rank test. Results. Seventy-four femoral-infrapopliteal bypasses with ePTFE were performed in 67 patients for limb salvage. At 24 months the primary patency, assisted primary patency and secondary patency rates were 40% +/- 10% (SEM), 48% +/-: 11%, and 52% +/- 11%, respectively. Limb salvage was successful in 62% +/- 10% of the bypasses at 24 months. Forty-six percent of the bypasses were performed with an AVF; 35% were performed with direct end-to-side anastomosis, and 19% were performed with a vein patch anastomosis. Apparent trends in favor of the AVF group did not attain statistical significance with 24-month patency rates of 65% +/- 19%, 44% +/- 16%, and 35 % +/- 20%, respectively, in the 3 subgroups. Limb salvage rates were similar (64% +/- 17%, 56% +/- 15%, and 76% +/- 22%, respectively) at 24 months. Conclusions. Patency and limb salvage rates are sufficient to justify the use of ePTFE grafts in infrapopliteal bypass when adequate autogenous material is unavailable.