The current status of prosthetic-vein composite grafts for lower extremity revascularization.

When infrageniculate lower extremity vascular reconstructions are required in the face of inadequate or insufficient autogenous vein, prosthetic-vein composite grafts remain a viable alternative. Graft patency and limb salvage for composite grafts are intermediate between those of completely autogenous and prosthetic bypasses alone. The sequential technique may offer superior patency in patients with the appropriate anatomy. The addition of adjunctive techniques such as a distal arteriovenous fistula and/or anticoagulation may further improve results. An algorithm illustrating the proper role of composite grafts for distal lower extremity reconstructions is shown in Figure 6. Any significant interval of patency is important in this group of patients in whom limb salvage can often be achieved by healing ischemic lesions and in whom overall life expectancy is limited.