Late results of two hundred seventeen femoropopliteal bypasses to isolated popliteal artery segments (original) (raw)

1991, Journal of Vascular Surgery

A 10-year-experience of 217 femoropopliteal bypasses to isolated popliteal artery segments in 207 patients is reported.Thirty-three femoropopliteal bypasses (15%) were performed with reversed saphenous vein and 184 (85%) with polytetrafluoroethylene grafts. Operative indications were gangrene in 121 (56%), nonhealing ulceration in 40 (18%), ischemic rest pain in 51 (24%), and claudication in 5 (2%) cases. The 5-year primary graft patency rate of these bypasses was 59% (reversed saphenous vein, 74%; polytetrafluoroethylene, 55%;p < 0.05), the secondary 5-year graft patency rate was 61% (reversed saphenous vein, 79%; polytetrafluoroethylene, 56%;p < 0.05), and the 5-year limb salvage rate was 78% (reversed saphenous vein, 78%; polytetrafluoroethylene, 78%). The 30-day operative mortality rate was 10%, and the 5-year patient survival rate was 38%. Eleven patients (5%) required lower extremity amputation because of progressive gangrene or extensive infection despite a patent bypass to an isolated popliteal artery segment. We conclude that femoropopliteal bypasses to isolated popliteal artery segments (1) have acceptable 5-year graft patency and limb salvage rates; (2) should be performed with reversed saphenous vein grafts when possible; (3) may be performed with polytetrafluoroethylene grafts ffnecessary, with a resulting limb salvage rate equal to that of reversed saphenous vein grafts; and (4) require sequential extension to an infrapopliteal artery in up to 20% of patients. In addition, the presence of an isolated popliteal artery segment is associated with a high operative mortality rate and limited life expectancy because of coronary artery disease. (J Vase SVgG 1991;14:386-90.) In 1967 Mannick et al.z reported that limb salvage could be achieved in patients with an isolated popliteal artery (IPA) segment by performing a femoropopliteal bypass (FPB) with reversed saphenous vein (RSV). Subsequently, FPBs to IPA segments performed with expanded polytetrafluoroethylene (PTFE) grafts were shown to afford acceptable short-term patency and limb salvage rates. 2 Despite these and other encouraging reports of FPBs to IPA segments, 3.n the results of FPB are still believed by many to be dependent on the adequacy 386 the runoff bed as determined by arteriography. In addition, few reports exist of late results with bypasses to IPA segments, and a widespread belief is held that such procedures with PTFE grafts have poor results and should not be performed.