Faculty Bibliography

In a retrospective study of 66 PTFE arteriovenous fistulae and 71 BCH arteriovenous fistulae for dialysis access, PTFE had a higher patency rate than BCH at 12 months (62.4 versus 32.5%). PTFE was easier to work with and easier to handle in the face of infection. The lateral upper arm approach to placement of the PTFE graft is desirable in patients who have had multiple previous access procedures because this area is usually free from scarring, is distant from neurovascular structures, and provides a greater length of graft for needle punctures

Because our femoropopliteal reconstructions with expanded polytetrafluorethylene (PTFE) and saphenous vein have comparable patency rates up to 22 months, we used this prosthetic for longer, more complex bypasses for limb salvage. Fourteen axillopopliteal or cross-over axillopopliteal bypasses were performed largely because groin infection or deep femoral artery disease precluded standard procedures; 12 are patent up to 14 months. Five patients required a bypass from one femoral artery to an opposite leg artery; four are patent up to 17 months. Because of progressive necrosis, eight patients required a secondary extension from a femoropopliteal bypass to a distal artery; five are patent up to 12 months. Three patients required extra-anatomic bypass for leg or popliteal space infections; all achieved limb salvage up to 12 months. Twenty patients without other suitable proximal arteries required a bypass to the dorsalis pedis or anterior tibial artery at the ankle; 10 are patent up to 14 months. Eleven patients required posterior tibial bypass at or below the ankle; seven are patent up to 18 months. One postoperative death followed these 61 procedures. Thus these operaions with long PTFE grafts that cross multiple joints can salvage limbs for important periods of time with low risk

Polytetrafluoroethylene bypasses were used in a series of 56 reconstructions, to the popliteal artery in 45 instances or below in 11 instances. These were performed in high risk situations in patients who usually did not have a suitable saphenous vein. Autologous saphenous vein bypass grafts were performed in a comparable series of 56 high risk situations. The polytetrafluoroethylene reconstruction was patent at four to 14 months in 43 of 45 patients having femoropopliteal bypasses, with limb salvage in 39 of the 45. The saphenous vein bypass was patent at eight to 14 months in 39 of 45 patients having femoropopliteal reconstructions, with limb salvage in 36 of the 45. Distal--small vessel--bypass patency rates were similar for reconstructions with polytetrafluoroethylene and saphenous vein. No increase in the number of deaths or complications was observed in the polytetrafluoroethylene group, rather, a general reduction was noted in the operating time and in the incidence of wound complications. These results justify the continued use of polytetrafluoroethylene grafts in patients without saphenous veins who require arterial reconstructions of the lower extremity for limb salvage. The exact place of polytetrafluorethylene grafts in reconstructive surgery of arteries in the lower extremity awaits definition based upon longer periods of observation

One hundred ten arterial reconstructions, including several new and extended bypasses, were performed with polytetrafluoroethylene (PTFE) grafts and were observed for three to 16 months. Patency rates were 100% with 15 bypasses to the femoral artery, 95% with 66 bypasses to the popliteal artery, and 76% with 29 bypasses to the arteries of the leg and foot. These encouraging preliminary results justify continued use and evaluation of PTFE as an arterial prosthesis

Polytetrafluoroethylene (PTFE) bypasses were used in a series of arterial reconstructions to the popliteal artery (45) and to arteries below that level (11). These were performed in high-risk situations in patients who lacked a suitable saphenous vein. Vein bypasses were performed in a comparable series of high-risk situations in patients having a suitable autologous saphenous vein (45 to the level of the popliteal artery and 11 to an artery below that level). PTFE patency rates at 4-14 months were 43 to 45 (96%) for the femoro-popliteal reconstructions (with a limb salvage rate of 39 to 45 or 87%) and 5 of 11 (45%) for the distal bypasses. Saphenous vein bypass patency rates at 8-14 months were 39 of 45 (87%) for the femoropopliteal reconstructions (with a limb salvage rate of 36 of 45 or 80%) and 5 of 11 (45%) for the distal bypasses. These results justify continued use of PTFE grafts in patients without saphenous veins who require lower extremity arterial reconstructions for limb salvage. The exact place of PTFE grafts in arterial reconstructive surgery of the lower extremity definition based on longer periods of observation