Vascular grafts in below-knee femoro-popliteal bypass. A comparative study.

In 40 patients below-knee femoro-popliteal bypass grafts (autogenous saphenous vein, ePTFE, ring-supported ePTFE, double-helix supported ePTFE, noncrimped coil-supported Dacron) have been analysed by an early postoperative angiography in 90 degree knee bent lateral position. Autogenous vein grafts almost constantly show an ideal position. Coil-supported Dacron as well as ring-supported ePTFE and double-helix-supported ePTFE proved to be a valuable substitute, whereas the conventional ePTFE bypass showed considerable kinking due to its minimal longitudinal elasticity. Those kinks lead to turbulence, jet phenomena and, in the long term, to neointimal proliferations. This might be the cause of late failures. The most important advantage of the three different ePTFE grafts in our experience is the possibility of thrombectomy at any interval after the operation.