Is the preferential use of polytetrafluoroethylene grafts for below-knee femoropopliteal bypass justified?

The usefulness of polytetrafluoroethylene graft (PTFE) for primary below-knee femoropopliteal bypass was examined. Forty-five primary femoropopliteal bypasses with PTFE were performed in 35 patients during a 7-year period. Patients were divided into two groups: above-knee (A-K group, n = 20) and below-knee (B-K group, n = 25) bypass. Differences in intergroup patient demographics were not significant. The primary patency rate in the A-K group at 3 and 5 years was 83.6% and 50.2%, respectively, and was 76.2% at both 3 and 5 years in the B-K group. These differences were not significant. Cause of graft failure, 3 grafts in the A-K group and 5 grafts in the B-K group, was kinking or thrombus formation associated with intimal hyperplasia at the distal anastomosis. All grafts in the A-K group with more than 10% stenosis in the early postoperative period had more than 50% stenosis in the late postoperative period. On the other hand, the one graft in the B-K group with 25% stenosis in the early postoperative period had 50% stenosis in the late postoperative period. We concluded that the use of PTFE for primary below-knee femoropopliteal artery is reasonable when atherosclerosis in the proximal popliteal artery is slight. However, close follow-up is necessary to detect and treat graft stenosis early.