Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#7 LONG-TERM RESULTS OF INFRAPOPLITEAL BYPASS WITH POLYTETRAFLUOROETHYLENE AND TAYLOR VEIN PATCH FOR CRITICAL LOWER EXTREMITY ISCHEMIA
Marc A. Passman, MD, William A. Marston, MD, Robert E. Carlin, MD, Mark A. Farber, MD, Steven J. Burnham, MD, Joseph P. Archie, MD, and Blair A. Keagy, MD The University of North Carolina Chapel Hill, NC
Purpose: Although distal vein patch techniques have been advocated to improve the patency of lower extremity bypass grafts with polytetrafluoro-ethylene (PTFE), use of this approach in the infrapopliteal position remains unproven. The purpose of this study is to evaluate the results of infrapopliteal bypass grafting using PTFE and Taylor vein patch for critical lower extremity ischemia.
Methods: All patients undergoing infrapopliteal bypass grafting with PTFE and Taylor vein patch for ischemic rest pain or tissue loss were identified from our vascular surgery registry. This report describes results for surgical morbidity and mortality, patency, limb salvage, and survival for procedures performed from 1993 through 1997.
Results: Of 488 infrapopliteal bypass grafts placed for critical lower extremity ischemia during the 5 year period, 42 (8.6%) were with PTFE and Taylor vein patch. Surgical indications were rest pain in 25 (60%) patients and ischemic tissue loss in 17 (40%). Distal arterial anastomosis included 17 (40%) anterior tibial, 10 (24%) peroneal, 8 (19%) posterior tibial, and 7 (17%) tibioperoneal arteries. Follow-up ranged from 1 to 52 months (mean 17 months). Life table primary patency, secondary patency, limb salvage, and survival at 3 years were 20%, 31%, 45%, 62%, respectively (standard error <0.10). There were 3 (7%) perioperative deaths and 9 (21%) major complications including graft or wound infection (3), myocardial infarction (3), postoperative hemorrhage from distal anastomotic vein patch (1), and late distal anastomotic pseudoaneurysm requiring repair (2).
Conclusions: Infrapopliteal bypass with PTFE and Taylor vein patch for critical lower extremity ischemia has poor long-term patency, reflecting the severity of arterial occlusive disease in this end-stage population. These results are comparable to those reported for PTFE without Taylor vein patch and inferior to those reported for alternative or spliced autologous vein.
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Last updated January 10, 1999