Bypasses to Tibial Vessels Using Polytetrafluoroethylene as the Solo Conduit in a Predominantly Diabetic Population

Abstract

The authors reviewed the Vascular Surgery Registry at the Beth Israel Deaconess Medical Center between 1990 and 1996 and identified 45 patients (47 limbs) who underwent bypass with polytetrafluoroethylene alone to infra-popliteal vessels. This represented only 2.6% of total tibial bypasses performed during that time. Sixty-nine percent of patients had diabetes. Indication for bypass was limb salvage in 96% of patients. Primary and secondary patency rates at 30 days, 1, 3, and 5 years were 87%, 87%; 58%, 60%; 41%, 43%; and 36%, 39%; respectively. Limb salvage rates at 30 days, 1, 3, and 5 years were 91%, 68%, 63%, and 63%. Cumulative survival rates at 3 and 5 years, however, were 53%, and 42%. The 29 grafts (64%) that were postoperatively anticoagulated with sodium warfarin showed trends in improved primary patency (47% vs 19%, p = 0.07), secondary patency (49% vs 20%, p = 0.03), and limb salvage (67% vs 58%, p = 0.06), at 3 years. There were no significant differences between diabetics and non-diabetics except in a trend toward decreased patient survival at 3 and 5 years in the diabetic population. Postoperatively, there were no deaths but there were two (4.2%) major cardiac complications. These data support the judicious use of tibial vessel bypass using PTFE in selected patients for limb salvage when autologous vein is not available. Diabetic patients appear to have similar results to non-diabetics and the postoperative use of sodium warfarin is beneficial.