Femorotibial and femoroperoneal bypass vein grafts. A 15-year experience
G. P. Kacoyanis, A. D. Whittemore, N. P. Couch and J. A. Mannick
Results with 111 femoral-infrapopliteal vein grafts in 105 patients were
subjected to life-table analysis. The overall five-year cumulative graft
patency rate of 46% was associated with a 60% limb salvage rate. In cases
in which the infrapopliteal graft represented the initial operative
procedure, the five-year limb salvage and patency rates (69% and 56%,
respectively) were significantly higher (P less than .05) than those
achieved with secondary grafts (38% and 22%, respectively). Most limbs
(79%) with failed intrapopliteal grafts, without further attempts at
reconstruction, required major amputation within six months. The site of
the distal anastomosis (anterior tibial, posterior tibial, or peroneal
arteries) proved not to be a significant factor in determining long-term
limb salvage or graft patency rates. Furthermore, the differences between
five-year salvage and patency rates in diabetics (45% and 32%,
respectively) and nondiabetics (65% and 53%, respectively) approached but
did not reach statistical significance. It is believed these observations
support the established but controversial role of infrapopliteal bypass in
advanced peripheral occlusive diseases.
