|Authors||Feinberg RL, Winter RP, Wheeler JR, Gregory RT, Snyder SO, Gayle RG, Parent FN, Adcock GD|
|Journal||J. Vasc. Surg. Volume: 12 Issue: 3 Pages: 257-63|
|Publish Date||1990 Sep|
We retrospectively reviewed the results of 108 consecutive femorocrural bypasses performed with prosthetic/autogenous composite graft material and compared these with the results of 57 crural bypasses using greater saphenous vein by the in situ technique. Indication for operation in all cases was the salvage of an otherwise imminently threatened limb. Polytetrafluoroethylene-composite grafts (n = 87) and human umbilical vein-composite grafts (n = 21) were placed only in patients lacking suitable autogenous material for in-line reconstruction. Patient groups were similar with respect to mean age, prevalence of arterial disease risk factors, quality of the distal runoff, and location of the distal anastomosis. Cumulative patency rates at 1 year by life-table analysis were 81.9%, 34.6%, and 12.1% for the in situ, polytetrafluoroethylene-composite and human umbilical vein-composite groups, respectively. At 2 years these were 63.9%, 29.9%, and 6.0%, respectively (p less than 0.025). Cumulative limb salvage at 1 year was 70.6%, 62.3%, and 32.7%, respectively. Wound-related complications occurred in 52.4% of human umbilical vein-composite, 38.6% of in situ, and 18.3% of polytetrafluoroethylene-composite bypasses (p less than 0.05). On the basis of these results, we conclude that femorocrural bypass with polytetrafluoroethylene-composite graft is an acceptable form of distal reconstruction for limb salvage in patients lacking sufficient lengths of autogenous vein. We no longer use human umbilical vein for composite construction.