Composite sequential grafts in severe ischemia: a comparative study.

From October 1978 to June 1983, 64 sequential bypass grafts were performed in 59 patients with limb-threatening ischemia. These patients were classified into three study groups as follows: reversed saphenous vein graft alone (12), composite sequential (proximal polytetrafluoroethylene [PTFE] and distal vein) graft (30), and PTFE graft in entirety (22). Graft patency was confirmed in all cases by serial Doppler ankle pressure measurements or by angiography. Cumulative life-table patency rates were then compared over a period of 27 months. The patency rates for composite sequential grafts using a distal short segment of vein were statistically indistinguishable from those for bypasses performed entirely with saphenous vein. These yielded a patency rate of 80% at 1 and 2 years. In contrast, the 1- and 2-year patency rates of the PTFE sequential grafts were 52% and 47%, respectively (p less than 0.05). Composite sequential bypasses using an otherwise inadequate segment of saphenous vein are a sound alternative revascularization procedure, with a patency rate comparable to that of reversed saphenous vein bypasses.