Comparison Between Autogenous Saphenous Vein and Heparin-Bonded Expanded Polytetrafluoroethylene for Below-the-Knee Popliteal and Tibial Bypasses in Patients With Critical Limb Ischemia

Objective: To retrospectively compare the outcomes of heparin-bonded expanded polytetrafluoroethylene (HePTFE) and autogenous saphenous vein (ASV) in patients undergoing below-the-knee (BTK) femoropopliteal bypass for critical limb ischemia (CLI). Methods: From January 2002 to December 2022, 337 BTK bypasses were performed in patients with CLI: 145 with ASV and 192 with a HePTFE graft. Perioperative outcomes were analyzed in terms of mortality, thrombosis, reinterventions, and early amputation, and compared with an χ2 test. Follow-up outcomes were analyzed in terms of survival, primary patency, secondary patency, limb salvage, and amputation-free survival with Kaplan-Meier curves and a log-rank test. Results: There were no differences in terms of perioperative outcomes. The median duration of follow-up was 37 months. The estimated 10-year survival rate was 46% in the HePTFE group and 49.7% in the ASV group (P = .8, log-rank 0.07). Primary patency rates at 10 years were 26% in the HePTFE group and 36% in the ASV group (P = .1, log-rank 2.2). Secondary patency rates were 29% (standard error [SE] 0.06) and 36.6% (SE 0.08), respectively (P = .7, log-rank 0.08). Amputation-free survival rates were 38% (SE 0.06) and 40.5% (SE 0.05), respectively (P = .9, log-rank 0.09). The presence of coronary artery disease, ulcers or gangrene, and the need for tibial anastomosis were independent predictors of death and/or amputation during follow-up. Conclusions: HePTFE demonstrated comparable 10-year outcomes to those achieved with ASV in patients with CLI undergoing BTK or tibial bypass, particularly in the BTK setting, whereas, in the tibial artery, the performance of both materials was extremely poor.