Prevention and management of polytetrafluoroethylene graft complications in peripheral vascular reconstruction.

The use of expanded PTFE grafts as a vascular substitute has been well established. PTFE is an acceptable alternative for patients in whom the saphenous vein is unusable. Nonreinforced PTFE grafts do a better job of resisting infection, permitting cellular ingrowth, and allowing the development of a true neointima. During a 6 year period ending in April 1981, 129 grafts were placed in various positions. Most of these were placed primarily in the femoropopliteal position. One death occurred as a direct result of the surgery. Only two infections were encountered, both were delayed and patient-induced. There were no true aneurysms in the PTFE grafts of our patients. The use of smooth noncrushing clamps applied gently with just enough pressure to stop blood flow will lessen the likelihood of aneurysmal formation. Careful surgical technique can minimize problems. False aneurysm in vascular reconstruction can largely be prevented by the proper establishment of hemostasis at the suture line. Selection of an appropriate needle and suture along with the use of proper technique in their placement will help provide the best possible results. One should follow the curve of the needle at the time of suturing to help prevent elongation of the suture holes, which may contribute to difficulties in establishing hemostasis at the suture line. Thrombosis is the most common problem associated with the use of this graft; correction requires careful balloon catheter techniques. Salvage of the graft can be obtained by endarterectomy, patch grafting, or jump grafts so that the entire prosthesis does not have to be replaced.