Comparison of above-knee and below-knee anastomosis in femoropopliteal bypass grafts
D. C. Brewster, A. J. LaSalle and R. C. Darling
Experience with 555 femoropopliteal reconstructions was reviewed to
evaluate the optimal location of the distal anastomosis. Autogenous vein
was employed in 347 (63%) grafts and various prosthetics in 208 (37%). Vein
grafts demonstrated marked superiority in late patency (73% at five years)
vs prosthetic grafts (35% at five years). Below-knee (BK) anastomosis
resulted in slightly better long-term patency in the vein graft group. In
contrast, above-knee (AK) anastomosis was clearly preferable when
prosthetic grafts were employed, particularly in patients with poor runoff
or limb-threatening ischemia. The incidence of major amputation was greater
following failure of BK grafts, reflecting the fact that a greater
proportion of such grafts were done for limb salvage. However, failure of
BK grafts did not appear to alter the level of amputation as compared with
failed AK grafts.
