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Polytetrafluoroethylene Bypasses to Infrapopliteal Arteries Without Cuffs, Patches or other Adjunctive Procedures: A 20-Year Experience

Objectives: Polytetrafluoroethylene (PTFE) tibial and peroneal bypasses without vein cuffs, patches or arteriovenous fistulas have been primarly used at our institution for limb salvage when autologous saphenous vein is not available. This reviews our 20-year experience.
Methods: A retrospective analysis was performed on a group of 259 patients undergoing infrainguinal limb salvage at our institution between June 1983 and June 2003. These 259 patients underwent 271 PTFE bypasses to a tibial or peroneal artery without any adjunctive procedure. Tourniquet control of the tibial or peroneal artery was used in the majority of cases (85%). Cumulative life table primary and secondary patency and limb salvage rates were calculated for those bypasses performed between June 1983 and June 1993 (Group I). These were compared to those performed between June 1993 and June 2003 (Group II). Total distal anastomotic time was also recorded. Data was analyzed using Fisher’s exact test.
Results: Overall 3-year primary and secondary patency, limb salvage, and anastomotic time for Group I patients was 28%, 43%, 66%, and 33 minutes, respectively, and for Group II patients was 47%, 54%, 74%, and 69 minutes, respectively. Primary patency for Group II patients significantly exceeded that observed in Group I patients, and this correlated with overall distal anastomotic time.
Conclusions: PTFE bypasses without adjunctive procedures to infrapopliteal arteries are an option for those patients without autologous vein. Meticulous attention to the distal anastomosis is an important factor in predicting primary patency of these grafts.