Polytetrafluoroethylene (PTFE) femorodistal grafts with a distal vein cuff for critical ischaemia

Abstract

To analyse the results of PTFE femorodistal bypass grafts using a distal anastomotic vein cuff in the treatment of critical ischaemia. Prospective study of consecutive patients under the care of a single Vascular Surgeon. A dedicated Vascular Surgical Unit in a University teaching hospital. Fifty-one consecutive femorodistal PTFE grafts were performed on 50 patients (median 74 years, range 58-94 years, 25 men; median ankle:brachial index 0.4). In 28 (55%) a common ostium arteriovenous fistula (AVF) was fashioned at the distal anastomosis. The 30-day postoperative mortality was 8%, with 10 (21%) major complications. The 1 and 2 year primary patency was 64% and 51%, respectively, with corresponding limb salvage rates of 85% and 80%. The presence of an AVF did not significantly affect graft patency or patient survival, but appeared to hinder limb salvage. The latter effect may be due to bias in patient selection. PTFE femorodistal grafts with a distal vein cuff are a suitable alternative to autogenous saphenous vein in distal reconstructions for critical ischaemia. No conclusions can be made about the efficacy of an AVF in this context.