Peripheral Vascular Surgery Society

Nikhil Kansal, MD, Peter J. Pappas, MD, Gary A. Gwertzman, MD,

Michael B. Silva, Jr., MD, Zafar Jamil, MD, Frank T. Padberg, Jr., MD,

Bing C. Lee, MD, Florence Chan, MD, and Robert W. Hobson, II, MD

UMDNJ-New Jersey Medical School, Newark, NJ.

Purpose: Polytetrafluoroethylene (PTFE) is often utilized in patients with limb threatening ischemia requiring infrainguinal revascularization in the absence of autologous saphenous vein. To increase long-term patency of PTFE grafts, vein interposition cuffs have been recommended as adjunctive procedures. The purpose of this study was to assess the efficacy of vein interposition cuffs on the long-term patency and limb salvage of patients requiring prosthetic bypass grafts for limb threatening ischemia.

Methods: Prosthetic bypass grafts with vein interposition cuffs (PTFE/VC) were performed on 56 limbs in 55 patients (32 men, 23 women; mean age of 67 years) from October 1993 to January 1998. Grafts were prospectively evaluated every three months for the first 12 months and biannually thereafter with duplex ultrasonography.

Results: Indications for revascularization were critical limb ischemia in 21, tissue loss in 33 and disabling claudication in 2 patients. Patients were followed clinically for 1 to 37 months (mean of 13.7 months). Cumulative life table patencies at 12, 24, and 36 months for femoropopliteal (FP) and infrapopliteal (IP) bypasses were 72%, 54%, 30% and 62%, 54% and 30%, respectively. Previously reported patencies from our institution for PTFE bypasses without a vein interposition cuff at the same time intervals were 60%, 45% and 35% for FP and 22%, 12% and 12% for IP. Cumulative limb salvage rates at 36 months for PTFE/VC were 78% and 61% for FP and IP, compared to 54% and 22% for prosthetic grafts without vein interposition cuffs.

Conclusion: PTFE/VC and PTFE bypasses at the popliteal level appear to have comparable patencies. However, PTFE/VC appear to offer an improved patency and limb salvage for infrapopliteal bypasses in patients with critical limb ischemia. When infrapopliteal revascularization is required in the absence of autologous saphenous vein, we recommend the use of PTFE with vein interposition cuffs.