Usefulness of PTFE Graft in Above-Knee Femoropopliteal Artery Bypass

Purpose: Which graft material is appropriate for the above-knee femoropopliteal (AK fem-pop) bypass has been a controversy. We were to evaluate the usefulness of PTFE graft in AK fem-pop bypass by comparing the results of autogenous, vein graft in below-knee femoropopliteal bypass. Methods; This was a retrospective study of data for Fem-Pop bypass from August 1999 to August 2008. The median follow-up was 59.9 +/- 27.3 months. The demographic data, patency rate, secondary procedures, and amputation rate were compared, and statistical comparison was performed by Kaplan-Meier, method, Log-rank test, and Chi-square test. Results: Severity-three bypasses were performed in 63 patients: PTFE graft in 48 cases (Group A), autogenous vein in 25 cases (Group B). Sixty-one patients (96.81%) were men. The mean age was 67.3 +/- 8.0 years. The indication for surgery was intermittent claudication in 27 cases (37.0%), critical limb in 46 cases (63.0%). The 6-yr primary patency rates were 28.1%; 60.3%, the 6-yr secondary patency rates were 37.2 +/- 8.4%, 67.0 +/- 14.7% in Group A and Group B, respectively (P<0.05). The number of secondary procedures was 31 and 3, respectively (P<0.05). Major amputation at later periods was not needed in Group B, but there were 9 cases in group A (P<0.05). Conclusion: PTFE graft for above-knee femoropopliteal bypass shows poor long-term patency with a large number of secondary procedures and a higher amputation rate than vein raft in BK Fem-Pop bypass. PTFE graft should be limited to patients with high operative risk, or poor venous graft. (J Korean Surg Soc 2009;77:410-416)