What is the patency rate of an artery vein composite graft in a typical adult patient with a history of vascular disease?

Patency Rates of Artery-Vein Composite Grafts

Composite sequential grafts (prosthetic artery to above-knee popliteal artery with vein jump graft to distal vessel) achieve 28-40% patency at 5 years, making them an acceptable but inferior option reserved only when insufficient autogenous vein exists for a complete vein bypass. 1

When Composite Grafts Are Indicated

Composite sequential grafts should be considered only when vein length is inadequate for a complete autogenous bypass, after exhausting all alternative vein sources including lesser saphenous vein, contralateral greater saphenous vein, arm veins, and spliced vein segments. 1

• The ACC/AHA provides a Class I recommendation that composite sequential femoropopliteal-tibial bypass is an acceptable method of revascularization when no other form of bypass with adequate autogenous conduit is possible. 1
• This technique uses a prosthetic graft (PTFE or polyester) to the above-knee popliteal artery, followed by a vein "jump graft" to the more distal tibial or pedal vessel. 1

Comparative Patency Data

The composite graft strategy represents a compromise between pure prosthetic and pure vein grafts:

• Composite grafts to below-knee targets: 45% patency at 3 years 2
• Pure vein grafts to below-knee targets: 79% patency at 3 years 2
• Prosthetic-only grafts to above-knee popliteal: 47-50% patency at 5 years 3
• Prosthetic-only grafts to below-knee popliteal: 33% patency at 5 years 1, 3

Critical Clinical Context

The prosthetic component of composite grafts should terminate at or above the knee joint whenever possible, as crossing the knee joint with prosthetic material dramatically accelerates graft failure due to mechanical stress and poor outflow. 1

Factors That Improve Composite Graft Outcomes:

• Proximal anastomosis to common femoral artery with good inflow (no significant aortoiliac disease) 4
• Vein component anastomosed to least-diseased tibial or pedal artery with continuous flow to the foot 1
• Postoperative graft surveillance with duplex ultrasound for at least 2 years to detect stenoses amenable to salvage procedures 1, 4
• Indefinite antiplatelet therapy (aspirin or clopidogrel) initiated preoperatively 1

Common Pitfalls to Avoid

Never construct a composite graft without first exploring all autogenous vein sources, as even arm veins or spliced vein segments provide superior long-term patency compared to any prosthetic component. 1, 5

• Avoid using composite grafts for claudication alone—reserve this technique for critical limb ischemia when amputation is imminent and no pure vein option exists. 1
• Do not place the prosthetic-to-vein transition point below the knee, as this combines the worst aspects of both conduits (poor prosthetic patency below knee + increased complexity). 1
• Ensure the target vessel has <20% stenosis at origin and uncompromised outflow to the foot, as poor runoff accelerates composite graft failure even faster than pure prosthetic grafts. 1

Operative Mortality and Morbidity

Lower extremity revascularization in critical limb ischemia patients carries 1-6% operative mortality regardless of graft configuration, with major morbidity primarily from MI (0.8-5.2%) or renal failure (0-4.6%). 1