The performance of femoropopliteal bypasses using polytetrafluoroethylene above the knee versus autogenous vein below the knee

BACKGROUND: Controversy exists as to the choice of conduit for the treatment of superficial femoral artery occlusive disease, particularly when a patent above-knee popliteal artery exists. Some surgeons advocate the preferential use of polytetrafluoroethylene (PTFE), whereas others favor the use of autogenous vein. This report compares our experience with above-knee femoropopliteal bypass with PTFE versus below-knee femoropopliteal bypass with autogenous vein. METHODS: This study covers a 15-year period extending from 1982 to 1996 during which 1,313 arterial reconstructions were performed for superficial femoral and/or proximal popliteal arterial disease. Four hundred and thirty-eight procedures were performed to the above-knee popliteal artery using PTFE, and 875 procedures were performed to the below-knee popliteal artery using autogenous vein. The indication for surgery was limb salvage in 77% of patients in the PTFE group and 88% of patients in the vein group. RESULTS: The 1-, 3-, and 5-year cumulative life table primary patency rates for the PTFE group were 74%, 56%, and 50%, respectively. The primary patency rates for the vein bypass group were 83%, 75%, and 67%, respectively (P < 0.01). The 5-year cumulative limb salvage rates were 91% and 95% for the PTFE and vein groups, respectively (P = NS). CONCLUSIONS: In this series, below-knee femoropopliteal venous reconstructions have superior patency rates compared with above-knee femoropopliteal PTFE reconstructions. Venous reconstruction for femoropopliteal occlusive disease gives the optimal long-term result. Prosthetic reconstruction should be considered for patients with limited venous conduit or decreased life expectancy. (C) 1997 by Excerpta Medica, Inc.