The ideal material used for Femoro-Popliteal shunt is
(B) Reverse Saphenous veinInterventional Procedures: Lower extremitiesBypass graft:Synthetic: Polytetrafluoroethylene (PTFE), DacronAutogenous vein grafts:-Reversed; In situPercutaneous angioplasty (PTA)Stents Bypass Surgery:Some Bypass Options:Reverse the saphenous vein for femoro popliteal bypass.Synthetic prosthesis for - aortoiliac or ilio-femoral bypass.Others = iliac endarterectomy & thrombolysis.Current Cochrane review = not enough evidence for bypass >PCl.Percutaneous transluminal angioplasty (PTA) has proved very successful in dilating the iliac and femoro-popliteal segments; the results below the knee are less successful. Long occlusions may be treated by the technique of subintimal angioplasty where the guide wire crosses the lesion in the subintimal space (in the arterial wall) and a new lumen is created by inflation of the balloon. Complications occur in about 5 per cent of cases and include failure, haematoma, bleeding, thrombosis and distal embolisation.Autogenous saphenous vein gives the best results and can be used reversed or in situ after valve disruption.If the long saphenous vein is not available from either leg, short saphenous or arm veins may be used.If no vein is available, a prosthetic polytetrafluoroethylene (PTFE) graft may be employed, although patency rates are less; many surgeons construct the lower anastomosis using a small collar of vein (Miller cuff) between the PTFE and the recipient artery, which may improve patency.If no suitable vein is available, prosthetic material (usually PTFE) may be used, with or without a small vein collar (Miller cuff) at its distal end.A femoro-femoral crossover graft involves tunneling a prosthetic graft subcutaneously above the pubis between the groins.An axillo-femoral graft is tunneled subcutaneously between the axillary artery proximally, to reach one or both of the femoral arteries; the patency rates of an axillo-bifemoral bypass is better than an axillo (uni) femoral bypass.Results of operation:Long-term results of aortoiliac reconstructive surgery are good, usually marred only by progressive infrainguinal disease.Femoropopliteal surgery is less successful.Immediate postoperative success for vein bypass exceeds 90%, but the five-year patency is around 60%.PTFE-covered stents are engineered with a 30-100 micron pore size to allow for endothelial lining of the stent-graft and vessel healing. Only self-expanding covered nitinol stents should be used in femoropopliteal interventions.
Polytetrafluoroethylene (PTFE)
Reverse Saphenous vein
Polypropylene
Dacron
Venous Disorders