Extra-anatomic bypass with expanded polytetrafluoroethylene.

Expanded polytetrafluoroethylene has been used successfully for femoropopliteal bypass, aortopulmonary bypass and as a venous substitute. Thirteen patients with impending limb loss had extra-anatomic bypasses with expanded polytetrafluoroethylene. Five patients with unilateral iliac disease had femorofemoral bypass for impending limb loss, and five debilitated patients underwent axillofemoral and bifemoral bypass for limb salvage. Nine of ten patients had salvage of the extremities. Three patients had extended profundoplasty, two combined with polytetrafluoroethylene femoropopliteal bypass to isolated popliteal artery segments. Two of these patients had limb salvage. The patency rate is 92 per cent, and the limb salvage rate is 85 per cent in this difficult group of patients. The follow-up period extends to 28 months, and 12 patients are beyond one year. In six patients, polytetrafluoroethylene carotid subclavian bypass was performed for the subclavian steal syndrome; all patients had relief of the symptoms. One patient underwent axillary-axillary bypass with excellent results. Expanded microporous polytetrafluoroethylene with its high patency, shortened operating time, biocompatibility and excellent tissue incorporation is an excellent arterial substitute. The pliability and no requirement for preclotting make polytetrafluoroethylene ideally suited for patch angioplasty and suturing in areas difficult to expose.