Polytetrafluoroethylene bypasses to infrapopliteal arteries without cuffs or patches: A better option than amputation in patients without autologous vein

Purpose: This study was undertaken to evaluate our results of polytetrafluorethylene (PTFE) tibial and peroneal artery bypasses done for limb salvage. Methods: Within a group of patients undergoing infrainguinal limb salvage bypasses at our institution between January 1986 and May 1995, 63 patients faced an immediate amputation, had no autologous vein on duplex examination and operative exploration, and had only a tibial or peroneal artery as an outflow vessel for bypass. Most of these patients (82%) had two or more prior ipsilateral infrainguinal bypasses. These 63 patients underwent 66 PTFE bypasses to a tibial or peroneal artery without a distal anastomotic vein cuff or an adjunctive arteriovenous fistula. Our results were then compared with those reported from infrapopliteal (crural) bypasses performed with alternate autologous vein sources or PTFE in conjunction with various recommended adjuncts. Results: The 3- and 5-year cumulative primary graft patency rates for our PTFE infrapopliteal bypasses were 39% +/- 7% and 28% +/- 9%, respectively. Secondary graft patency rates were 55% +/- 8% and 43% +/- 10% at 3 and 5 years, respectively. Limb salvage rates were 71% +/- 7% at 3 years and 66% +/- 8% at 5 years. Two-year actuarial patient survival rate was only 67% +/- 7%. Conclusions: These results indicate that a PTFE bypass to an infrapopliteal artery remains a worthwhile option in patients without usable autologous vein. The secondary patency and limb salvage rates were acceptable in this setting and were not significantly different from the best results reported with prosthetic tibial/peroneal bypasses with distal vein cuffs or patches (74% at 1 year; 58% at 3 years), arteriovenous fistulas (71% at 1 year) or composite arm vein grafts (39% and 29% at 3 and 5 years, respectively).