Avoiding early failure of tibial prosthetic bypass grafts.

In a series of 97 tibial reconstructions using PTFE bypass grafts the value of perioperative anticoagulation was studied. Acetylsalicylic acid as well as low-dose heparin treatment resulted in a high graft failure rate during the first postoperative days (42%). Patency could be restored in half of the cases by simple thrombectomy. When heparin was given at a dose of 1000 I.U. per hour for two days the graft failure rate was 14%. Only one out of eight thrombosed grafts could be re-opened by thrombectomy. Long-term patency, however, was similar in both groups. We conclude that perioperative heparin treatment is a suitable method to avoid unnecessary thrombectomies of long prosthetic bypass grafts.