Expanded polytetrafluoroethylene femoropopliteal grafts: forty-eight-month follow-up.

Ninety-eight expanded polytetrafluoroethylene (PTFE) grafts were used for femoropopliteal reconstruction in 81 patients. Forty-eight-month follow-up is now available for 20 grafts and 36-month follow-up is available for 51 grafts. Seventy-four percent of the patients were men. Thirty-one percent had diabetes mellitus, 38% had hypertension, 36% had atherosclerotic heart disease, 18% had prior myocardial infarction, 17% had a previous operation for aortoiliac disease, and 14% had a previous ipsilateral femoropopliteal bypass procedure. The indication for operation was claudication in 47%, rest pain in 20%, and ischemic pregangrene or gangrene in 32% of patients. Distal runoff was angiographically graded as good (76%) or poor (24%). Seventy-three grafts were anastomosed to the proximal or midpopliteal artery (above the knee); 25 grafts were anastomosed to the distal popliteal artery (below the knee). Graft occlusion was determined by the return of ischemic symptoms, disappearance of previously palpable pulses, or by angiographic or Doppler assessment. There were no operative deaths. Nonocclusive causes of graft loss were death (7), amputation (2), infection (2), and aneurysm (5). The overall cumulative patency rate calculated by the life-table method, according to the criterion of occlusion alone, was 75% at 6 months, 68% at 2 years, 58% at 3 years, and 48% at 4 years. Preoperative symptoms, the number of patent outflow vessels, popliteal anastomosis placed above or below the knee, or hypertension did not adversely affect graft patency. Diabetes mellitus was associated with significantly increased graft failure. The PTFE graft is an acceptable alternative for femoropopliteal reconstruction for the patient without a suitable autologous saphenous vein.