The effect of distal anastomotic site on PTFE graft patency in lower extremity bypass

The site of distal anastomosis of polytetrafluorethylene (PTFE) lower extremity bypass grafts may significantly affect results. We examined patency in 144 cases; 45 femoro-popliteal above knee (AK), 55 femoro-popliteal below the knee (BK) and 44 femoro-distal (D) PTFE bypasses, the groups being comparable with regard to other risk factors studied. Cumulative graft patency at 3 years was 71.3% for AK, 36.7% for BK, 16.4% for D and overall 35%. The site of distal anastomosis is an important determinant, of PTFE lower extremity bypass patency. We have abandoned the use of PTFE for BK and D, but feel that AK PTFE is a suitable alternative to autogenous reversed saphenous vein.

Limb salvage in the elderly

Sixty-eight lower extremity bypass procedures for severe lower limb ischemia were undertaken on 53 patients of 75 years of age and over. The operative mortality was 4.4%. At two years cumulative limb salvage, patient survival, graft patency and survival with an intact limb were 77%, 72%, 44%, and 56%, respectively. Of all patients who died, 66% had an intact limb at the time of death. Based on these results we continue to offer reconstructive surgery to elderly patients.