Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jun;33(2):65-71.
doi: 10.5758/vsi.2017.33.2.65. Epub 2017 Jun 30.

Results of Infrainguinal Bypass with a Composite Graft Combining Polytetrafluoroethylene and Vein Graft in Absence of Appropriate Saphenous Vein Graft

Myung Jae Jin  1 , Ui Jun Park  2 , Hyoung Tae Kim  2 , Young-Nam Roh  2
Affiliations

Results of Infrainguinal Bypass with a Composite Graft Combining Polytetrafluoroethylene and Vein Graft in Absence of Appropriate Saphenous Vein Graft

Myung Jae Jin et al. Vasc Specialist Int. 2017 Jun.

Abstract

Purpose: Use of a composite graft combining a polytetrafluoroethylene graft with an autogenous vein is an option for limb salvage in the absence of an adequate single segment vein graft. We aimed to investigate the results of infrainguinal bypass with a composite graft.

Materials and methods: We retrospectively reviewed 11 infrainguinal arterial bypasses on 11 limbs which underwent surgery from March 2012 to November 2016.

Results: Critical limb ischemia was common (63.6%) indication of bypass surgery and most (90.9%) of the patients had history of failed previous treatment including endovascular treatment (36.4%) and bypass surgery (72.7%). At the 2 years after graft implantations, primary patency and amputation-free survival of below-knee bypasses using composite graft were 73% and 76%, respectively.

Conclusion: Infrainguinal arterial bypasses with composite graft had an acceptable patency. In patients without other alternative conduits for revascularization, bypass with a composite graft can be an option.

Keywords: Bypass; Composite graft; Infrainguinal.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None.

Figures

Fig. 1
Fig. 1
Vein cuff at distal anastomosis for the anastomosis of the polytetrafluoroethylene graft to the posterior tibial artery (blue arrow). Vein cuff only at the distal anastomosis was not included in the composite graft. This popliteo-posteror tibial artery bypass graft was occluded on postoperative day 340.
Fig. 2
Fig. 2
Configurations used in infrainguinal bypass surgery with a composite graft in the absence of an appropriate single segment vein graft (yellow arrows: anastomosis between polytetrafluoroethylene graft and vein graft). (A) A 79-year-old female patient who underwent a right femoro-TPT bypass with a composite graft due to acute on chronic ischemia. Run-off vessels were very poor (blue arrow). Transmetatarsal amputation was needed but the limb was salvaged. (B) A 67-year-old male patient who underwent a right femoro-TPT bypass with a composite graft due to critical limb ischemia caused by a previous bypass graft occlusion. (C) A 73-year-old male patient who underwent a right femoro-above knee popliteal and posterior tibial artery graft bypass with a composite graft due to critical limb ischemia caused by a previous bypass graft occlusion. The patient had a history of multiple failed endovascular treatments. Transmetatarsal amputation was needed but the limb was salvaged. TPT, tibioperoneal trunk.
Fig. 3
Fig. 3
Kaplan-Meier curve demonstrating primary patency and amputation-free survival (mean follow-up duration= 506.9±302.9 days, range=182–920 days).
Fig. 4
Fig. 4
Femoro-TPT bypass with composite graft using a PTFE graft and the proximal part of the ipsilateral great saphenous vein. (A) Distal anastomosis of the short segment reversed great saphenous vein at the TPT. (B) Tunneled ringed 6 mm PTFE graft anastomosed proximally to the common femoral artery (green arrow) and saphenous vein graft tunneled to above the knee (blue arrow). (C) Anastomosis between the PTFE and saphenous vein grafts. (D) Completion of anastomosis: above knee segment was composed of PTFE graft and distal segment crossing the knee joint was composed of a reversed saphenous vein graft. TPT, tibioperoneal trunk; PTFE, polytetrafluoroethylene.
See this image and copyright information in PMC

References

    1. Hölzenbein TJ, Pomposelli FB, Jr, Miller A, Contreras MA, Gibbons GW, Campbell DR, et al. Results of a policy with arm veins used as the first alternative to an unavailable ipsilateral greater saphenous vein for infrainguinal bypass. J Vasc Surg. 1996;23:130–140. doi: 10.1016/S0741-5214(05)80043-6. - DOI - PubMed
    1. Taylor LM, Jr, Edwards JM, Brant B, Phinney ES, Porter JM. Autogenous reversed vein bypass for lower extremity ischemia in patients with absent or inadequate greater saphenous vein. Am J Surg. 1987;153:505–510. doi: 10.1016/0002-9610(87)90803-8. - DOI - PubMed
    1. Londrey GL, Ramsey DE, Hodgson KJ, Barkmeier LD, Sumner DS. Infrapopliteal bypass for severe ischemia: comparison of autogenous vein, composite, and prosthetic grafts. J Vasc Surg. 1991;13:631–636. doi: 10.1016/0741-5214(91)90346-V. - DOI - PubMed
    1. de Mello AV, Santos CM, Silva JL, Souza MT, Portilho MA, Guimarães AV, et al. In situ saphenous vein arterial bypass for infrainguinal revascularization: initial experience using an open technique. Int Angiol. 1991;10:126–132. - PubMed
    1. Taylor LM, Jr, Edwards JM, Porter JM. Present status of reversed vein bypass grafting: five-year results of a modern series. J Vasc Surg. 1990;11:193–205. doi: 10.1016/0741-5214(90)90262-9. discussion 206. - DOI - PubMed

LinkOut - more resources