Expanded polytetrafluoroethylene grafts for severe lower limb ischaemia.

Three years' experience with the use of expanded polytetrafluoroethylene grafts for severe lower extremity ischaemia are reported; 44 femoropopliteal bypasses were performed, 35 for limb salvage. The prosthesis was used when no saphenous vein was available (23) or to shorten operation time in infirm patients (21). Of 41 patients with a mean age of 70 years, 19 had significant ischaemic heart disease and 10 were diabetic. The mean follow-up period for patient grafts is now 16 months (4--39 months), and the overall life-table cumulative patency is 59 per cent at 6 months, 52 per cent at 1 year and 40 per cent at 2 years. No correlation was demonstrated between patency and run-off, diabetes or smoking, but above-knee grafts may do better than those below the knee. Twenty grafts have occluded leading to 12 amputations, 3 further reconstructions and 1 death. Nine other deaths have occurred from causes not directly related to the lower limb ischaemia, 4 perioperatively and 5 later. The graft described were used in elderly unfit patients, most of whom would have had amputations before the introduction of polytetrafluoroethylene grafts. The results presented support the continued evaluation of this prosthesis in such selected cases.