Secondary Infrageniculate Bypass with Polytetrafluoroethylene

Autologous saphenous vein is the preferred conduit for infrainguinal reconstructions. Patients requiring secondary infrageniculate bypass represent a challenging surgical problem. Often, patients requiring such surgery have had multiple bypass operations and lack usable saphenous vein. These patients may also be older and have complicated medical problems which may limit their total life expectancy. This report reviews 11 such patients who required secondary bypass procedures for limb salvage. All procedures were performed with thin-walled polytetrafluoroethylene (PTFE). No perioperative complications or deaths occurred. Four patients have subsequently died due to unrelated disease at 8, 12, 13, and 29 months after operation with clinically patent grafts. In the seven surviving patients, four grafts remain patent with a mean(s.d.) patency of 27(21) months. Three grafts occluded at 2, 4 and 20 months after surgery. By life table analysis, cumulative graft patency was therefore 68% at 24 months. It is concluded that in this high-risk population when no saphenous vein is available. PTFE may provide acceptable limb salvage when used in secondary infrageniculate reconstructions.