The role of graft material in femorotibial bypass grafts.

"Newer" graft substitutes are being widely used in arterial reconstructive procedures in the infrafemoral region. A retrospective study of 101 consecutive femorotibial bypass grafts compares autogenous saphenous vein (ASV), polytetrafluoroethylene (PTFE), and glutaraldehyde tanned (GA) human umbilical cord vein. Symptoms prompting arterial reconstruction was rest pain or tissue necrosis in 90%. Asv (57 bypasses) was the material of choice, but when inadequate or unavailable PTFE, (29 bypasses) or GA (15 bypasses) were used. The immediate and one year patency in ASV was 92--82%. A high incidence of failure occurred in both the PTFE and GA grafts so that patency at one year was 24 and 10% respectively. An overwhelming statistical significance occurs with respect to patency in the three groups of grafts (p = 0.0002). This extremely high incidence of failure in these graft materials has prompted us to use cephalic and basilic veins in those patients which we feel require arterial reconstruction for relief of symptoms.