Long-Term Results of Infrapopliteal Bypass Using Polytetrafluoroethylene and Taylor Vein Patch for Critical Lower Extremity Ischemia

Abstract

Although distal anastomotic vein patch and cuff techniques have been advocated to improve the patency of lower extremity bypass grafts with polytetrafluoroethylene (PTFE), use of this approach in the infrapopliteal position remains unproven. The purpose of this study is to evaluate the results of infrapopliteal bypass grafting using PTFE and Taylor vein patch for critical lower extremity ischemia. All patients undergoing infrapopliteal bypass grafting with PTFE and Taylor vein patch for ischemic rest pain or tissue loss were identified from the vascular surgery registry. This report describes results for surgical morbidity and mortality, patency, limb salvage, and survival for procedures performed from 1993 through 1998. Forty-two infrapopliteal bypass grafts with PTFE and Taylor vein patch were placed for critical lower extremity ischemia during the 6-year period. Surgical indications were rest pain in 25 (60%) patients and ischemic tissue loss in 17 (40%). Distal arterial anastomosis included 17 (40%) anterior tibial, 10 (24%) peroneal, eight (19%) posterior tibial, and seven (17%) tibioperoneal arteries. Follow-up ranged from 1 to 52 months (mean 17 months). Life-table primary patency, secondary patency, limb salvage, and survival at 3 years were 25%, 31%, 44%, and 66%, respectively. Infrapopliteal bypass with PTFE and Taylor vein patch for critical lower extremity ischemia has poor long-term results that are comparable to those reported for PTFE without Taylor vein patch.