Flow waveform assessment of polytetrafluoroethylene grafts for reconstruction of lower extremity arteries. A preliminary report.

On the basis of our findings that the outcome of reconstructive surgery for lower limbs could well be predicted by flow waveform analysis, we reviewed femoropopliteal arterial bypass operations involving the use of polytetrafluoroethylene (PTFE) grafts for 35 patients. Of 38 grafts, 26 were PTFE alone, and 12 were PTFE/vein composite grafts. Neither ankle pressure index nor angiographic distal runoff was of predictive value as a prognostic indicator. The cumulative patency rate, calculated by the life-table method, revealed the usefulness of flow waveform analysis for prediction of the outcome of PTFE grafts. In type 0 or I flow, the patency rate was 94% at 1 and 2 years and 79% at 3 years. In contrast, in type II flow, the patency rate was 74% at 1 year, 66% at 2 years, and 49% at 3 years, with a statistical significance at 2 and 3 years (p less than 0.05). Comparison of the result of PTFE grafts with that of PTFE/vein composite grafts showed superior results of composite grafts at 3 years after implantation (42% vs. 83%, p less than 0.05). These findings indicate that flow waveform analysis is useful for prediction of the outcome of PTFE grafts and that PTFE/vein composite grafts should probably be used, particularly in cases of abnormal blood flow.