Expanded Polytetrafluoroethylene and Dacron Grafts for Atherosclerotic Lower Extremity Occlusive Disease

Surgical revascularization for lower extremity arteriosclerotic occlusive disease, manifested by critical limb ischemia (CLI) and life-limiting claudication, has been enhanced by an expanding array of conduit choices. In the absence of a perfect arterial substitute, autologous vein possesses the most of these desired arterial characteristics and remains the preferred substitute. However, in up to 25% of patients with CLI, adequate autologous vein is unavailable because of prior use, intrinsic disease, or insufficient length or caliber for revascularization. In this setting an autologous vein is not necessarily the most appropriate conduit, and prosthetic conduit is preferred in some patients.

Expanded polytetrafluoroethylene (ePTFE), the most commonly used prosthetic graft for lower extremity bypass, was initially developed for industrial use as a chemically inert tubing and wire insulation. It was modified and first used as a vascular prosthesis in humans in 1976 to treat lower extremity atherosclerotic occlusive disease. Commercially available heparin-bonded ePTFE (HB-ePTFE) grafts have been developed in an attempt to improve graft patency. Since its initial application, the use of ePTFE has expanded to include dialysis grafts, grafts for abdominal aortic aneurysm repair, extra-anatomic grafts, and bypass grafts for aortoiliac and infrainguinal occlusive disease.

Dacron (polyethylene terephthalate) is a synthetic material that as a textile can be fashioned into a prosthetic graft by weaving, knitting, or braiding methods. Dacron grafts were used often in the early era of lower extremity arterial reconstruction, but initial mediocre results and the presumed increased thrombogenicity of this graft led to a decline in its use. However, Dacron grafts remain the graft of choice in aortic reconstruction for many surgeons, especially with coatings of collagen, albumin, or gelatin. There has been a reappraisal of and rekindled interest in Dacron grafts with heparin bonding for lower extremity arterial reconstruction.