Preliminary results with the use of expanded microporous polytetrafluoroethylene in vascular occlusive disease of the lower extremity.

The use of expanded microporous polytetrafluoroethylene (PTFE) as a small arterial substitute has been increasing. In this study 22 patients, averaging 66 years of age, underwent femoral popliteal or femoral distal tibial bypass. Risk factors included 1) previous atherosclerotic heart disease in 52 per cent, 2) previous myocardial infarctions in 43 per cent, 3) hypertension in 33 per cent, 4) diabetes mellitus in 27 per cent, 5) chronic obstructive pulmonary disease in 14 per cent, and 6) previous cerebral vascular accident in 14 per cent. The initial 30-day patency rate was 81 per cent, with long-termpatency being 73 per cent. Average operative time was 2 3/4 hours, with 81 per cent of patients undergoing intraoperative arteriography. Follow-up ranges from three to 13 months. The average pre- and postoperative ankle pressures were 54 mmHg and 100 mmHg, respectively. Four patients with failed grafts required amputation. One patients with a patent graft required amputation for gangrene secondary to diabetes. Other complications included multiple toe amputations, two superficial wound infections, one perforated cecum, and one pulmonary embolus. The initial and long-term patency rates of 81 per cent and 73 per cent, respectively, compare favorably to previous studies using autogenous saphenous vein. This suggests that expanded PTFE may be the initial arterial prosthesis of choice in high-risk or elderly patients. Longer follow-up is needed to determine if it will be a satisfactory substitute for autogenous saphenous vein in routine elective bypass for lower extremity occlusive disease.