Best graft for infra-inguinal approach bypass?
a) Dacron
b) PTFE
c) Polyester
d) Autologous vein
Ans: D Reference: Sabiston 20th ed; pg. 1774-1775 Explanation:
• Bypass surgeries are done for peripheral arterial occlusive diseases which are several enough (ie, more than rest pain) and not eligible for Endovascular approaches (ie, TASC C or D lesions meaning long segment occlusive disease or occlusion at trifurcation or bifurcation of vessels) • Another important criteria for bypass is, there should be sufficient length of normal distal vessel to allow for bypass anastomoses. • For Bypass, two most common conduits used are 
PTFE (Polytetrafluroethylene) – synthetic graft, used for larger vessels like iliac and axillary vessels Autologous vein (most commonly saphenous vein) – Autograft, so innate antithrombotic properties, most preferred for infrainguinal bypass as they size match well, better patency rates than PTFE Other graft is Dacron (polyethylene terephthalate or polyester) used in Aortic aneurysm repair • Saphenous vein used should be reversed, as they have valves which allow unidirectional flow. So saphenous vein should be reversed (turned upside down) for bypass to allow any interruption to blood flow. (Reversed saphenous vein graft)