Dacron and PTFE are woven and expanded plastics used as replacement blood vessels. They are immediately available in any length and diameter, which makes them valuable, and they are foreign material, which is their weakness.
Synthetic grafts made from Dacron or PTFE replace or bypass a damaged artery when the patient's own vein is unavailable, too small, or when there is no time to harvest one. They perform well in large, high flow vessels and less well in smaller limb arteries below the knee. Their main drawback is that, if they become infected, they usually have to be removed.
A manufactured graft has real advantages. It is on the shelf in any diameter and length, so no time is spent harvesting a vein and no second wound is created. In large, fast flowing vessels its performance is excellent, and for many aortic and iliac reconstructions it is the material of choice.
The picture changes in the limbs. Smaller vessels, slower flow and repeated bending at joints all work against a synthetic tube, and below the knee a vein graft stays open considerably longer. Synthetic grafts also have no living cells in their wall, so they cannot mount any defence against bacteria. A graft that becomes infected is usually beyond saving with antibiotics alone, and removing it means finding another way to supply the limb, often in a patient who is now much sicker.
For that reason synthetic material is generally avoided in contaminated wounds and in trauma, and reserved for clean, planned operations where no suitable vein exists, or where the vessel is large enough that plastic performs as well as anything.
The choice between vein and synthetic is made case by case, and being honest about the trade off is more useful than a blanket preference.
Imaging determines the length and diameter of graft required and the sites for each join.
Antibiotics are given before the incision and the field is prepared meticulously, because infection is the principal enemy of a synthetic graft.
The artery is exposed and controlled above and below the diseased or damaged segment.
The graft is sewn to healthy artery at each end with fine non absorbable sutures.
The graft is passed through healthy tissue planes, avoiding any contaminated area and any point where it would sit directly under a healing wound.
The graft is buried under well vascularised tissue. A graft lying under a thin or breaking down wound will eventually become exposed and infected.
Circulation beyond the graft is monitored. Antibiotics continue as prescribed. Wounds are inspected for early signs of infection.
Mobilisation with physiotherapy. Wound care is taken seriously, particularly in the groin, which is the commonest site of graft infection.
Wounds heal. Baseline surveillance imaging is arranged. Antiplatelet medication is established.
Lifelong surveillance and awareness of infection risk. Report any febrile illness and mention the graft to any treating clinician.
In large vessels a synthetic graft can perform for many years. In the limbs, and particularly below the knee, it blocks more often than a vein graft and needs closer surveillance. The graft never becomes living tissue; it remains a foreign body for life, and that carries a small permanent risk of infection, including years later after an unrelated illness or dental procedure. Patients with a synthetic graft should mention it to any clinician treating an infection anywhere in the body.
Infection is the risk that dominates decision making with synthetic material.
Protecting a synthetic graft is a long term commitment, particularly around infection.
In large vessels it does very well. In the smaller arteries of the leg a vein graft stays open considerably longer, because flow is slower and the graft bends with the joints.
Rarely. Bacteria form a film on the synthetic surface that antibiotics cannot penetrate, and there are no living cells in the graft wall to help. Removal is usually required.
A synthetic graft remains foreign material for life. Infections elsewhere in the body can seed onto it years later, which is why you should mention it to any clinician treating you.
Speed does matter in an unstable patient, and that is a legitimate reason. Otherwise the choice is driven by vessel size, vein availability and contamination, and the reasoning should be explained to you.
Synthetic material is used where it is genuinely the better choice, not because harvesting a vein takes longer. Where a graft does become exposed or infected, soft tissue cover and reconstruction are available from the same team.
The graft material itself adds to the cost compared with using the patient's own vein. Vascular reconstruction is commonly covered by health insurance and government schemes including PM JAY. A written estimate follows assessment.
The questions that follow being told a plastic graft is planned.
Ask your question →Usually because there is no usable vein, because the vessel is large enough that synthetic performs just as well, or because the patient is too unstable to spend the extra time harvesting one. If a good vein is available for a bypass below the knee, it is used.
It usually has to be removed, and the circulation rerouted by another path. This is why antibiotics before surgery, careful wound care and prompt reporting of any redness or fever matter so much.
Tell your dentist that you have a vascular graft and let them make that decision with your surgeon. Practice varies, and the point is that they know it is there.
No. Dacron and PTFE are not metallic and do not trigger security scanners.
In a large vessel, frequently many years. In a leg bypass, less reliably than a vein graft, which is why surveillance imaging is arranged and why narrowing is corrected before it becomes a blockage.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
