Autologous saphenous vein (ASV) and polytetrafluoroethylene (PTFE) grafts were compared in 845 infrainguinal bypass operations, 485 to the popliteal artery and 360 to infrapopliteal arteries. Life-table primary patency rates for randomized PTFE grafts to the popliteal artery paralleled those for randomized ASV grafts to the same level for 2 years and then became significantly different (4-year patency rate of 68% ± 8% [SE] for ASV vs. 47% ± 9% for PTFE, p < 0.025). Four-year patency differences for randomized above-knee grafts were not statistically significant (61% ± 12% for ASV vs. 38% ± 13% for PTFE, p > 0.25) but were for randomized below-knee grafts (76% ± 9% for ASV vs. 54% ± 11% for PTFE, p < 0.05). Four-year limb salvage rates after bypasses to the popliteal artery to control critical ischemia did not differ for the two types of randomized grafts (75% ± 10% for ASV vs. 70% ± 10% for PTFE, p > 0.25). Although primary patency rates for randomized and obligatory PTFE grafts to the popliteal artery were significantly different (p < 0.025), 4-year limb salvage rates were not (70% ± 10% vs. 68% ± 20%, p > 0.25). Primary patency rates at 4 years for infrapopliteal bypasses with randomized ASV were significantly better than those with randomized PTFE (49% ± 10% vs. 12% ± 7%, p < 0.001). Limb salvage rates at 3 1 2 years for infrapopliteal bypasses with both randomized grafts (57% ± 10% for ASV and 61% ± 10% for PTFE) were better than those for obligatory infrapopliteal PTFE grafts (38% ± 11%, p < 0.01). These results fail to support the routine preferential use of PTFE grafts for either femoropopliteal or more distal bypasses. However, this graft may be used preferentially in selected poor-risk patients for femoropopliteal bypasses, particularly those that do not cross the knee. Although every effort should be made to use ASV for infrapopliteal bypasses, a PTFE distal bypass is a better option than a primary major amputation.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine