Cuffed anastomosis for above-knee femoropopliteal bypass with a stretch expanded polytetrafluoroethylene graft

Abstract

To evaluate the patency and limb-salvage rates associated with cuffed anastomosis in above-knee femoropopliteal (FP) bypasses using prosthetic grafts. Between January 1997 and December 2005, 96 patients (99 limbs) underwent above-knee FP bypass grafting for peripheral vascular disease, with disabling claudication in 81%. All grafts were 6-mm, thin-walled, ringed, expanded polytetrafluoroethylene (ePTFE) stretch grafts anastomosed to the above-knee segment of the popliteal artery in an end-to-side fashion, with a protruding area created around the anastomotic toe and an angle of less than 30 degrees between the graft and the artery. Postoperatively, graft patency was monitored by several objective methods. Patency and limb-salvage rates were calculated by actuarial methods and Kaplan-Meier analysis. The mean follow-up period was 40.4 months; 15 patients were lost to follow-up. The 1-, 3-, and 5-year primary graft patency rates were 94.5%, 88.2%, and 85.7%, respectively. The 1-, 3-, and 5-year secondary patency rates were 95.6%, 94.1%, and 90.8%. The 1-, 3-, and 5-year limb-salvage rates were 98.9%, 97.3%, and 97.3%. There were three graft infections. The use of a cuffed anastomosis in FP bypass with an ePTFE stretch prosthesis appears to increase graft patency rates.