The fate of infrainguinal PTFE grafts and an analysis of factors affecting outcome

Ninety-five infrainguinal polytetrafluoroethylene (PTFE) bypass grafts were performed in 90 patients. Indications for surgery were severe claudication in 23 limbs (24%) and rest pain or tissue necrosis in 72 limbs (76%). Sixty-seven grafts (71%) were to the above knee popliteal artery and 28 (29%) to the infragenicular vessels. The primary, primary assisted and secondary graft patencies at 2 years in limbs with rest pain or tissue necrosis were 37, 42 and 46% respectively with a limb salvage rate of 65%. A univariate analysis was performed to identify preoperative risk factors which affected graft patency. Smoking, an ankle systolic pressure of less than 50 mmHg, presentation with rest pain or tissue necrosis and single vessel run-off all had a significant adverse effect on graft patency. However, multivariate analysis revealed that smoking was the only significant adverse variable. These findings support the view that PTFE grafts for limb salvage are worthwhile even if the distal anastomosis is below the knee and run-off is via a single vessel provided that the patient stops smoking.