TIBIAL BYPASS-GRAFTING FOR LIMB SALVAGE WITH RINGED POLYTETRAFLUOROETHYLENE PROSTHESES - RESULTS OF PRIMARY AND SECONDARY PROCEDURES

Purpose: In advanced peripheral ischemia, tibial artery prosthetic bypass grafting is virtually the last chance for limb salvage when conservative treatment and other methods of revascularization have failed. Methods: For this study we reviewed our 7 years of experience with below-popliteal artery polytetrafluoroethylene grafts implanted for limb salvage. Results: All results regarding graft patency and limb salvage were computed by actuarial methods and were presented in the form of life-table analysis. There were 211 grafts in 184 patients (195 limbs). Two and 5 years after the operation, primary patency rates were 37% and 23% and secondary patency rates were 45% and 25%, respectively. The main negative predictive factors for patency rate were an occluded primary plantar arch artery and poor vessel runoff. Primary bypass procedures had markedly better success rates than secondary (repeat) procedures, with primary patency rates of 52% at 2 years and 42% at 4 years, whereas the corresponding rates for secondary procedures were 22% and 14%, respectively. The 5-year cumulative limb salvage rate was 51% for the total series. Conclusion: Although the patency of prosthetic grafts is not as satisfactory as that of autologous vein grafts, the limb salvage rate justifies an aggressive approach to infrapopliteal bypass grafting with polytetrafluoroethylene protheses when the limb is threatened and vein is not available.