Popliteal-tibial bypass grafts in the management of limb-threatening ischemia
J. L. Ballard, J. D. Killeen and L. L. Smith
Department of Surgery, Loma Linda University Medical Center, Calif.
OBJECTIVES: To ascertain the cumulative rates of primary graft patency and
limb salvage and the frequency of proximal arterial disease progression in
patients with autologous saphenous vein bypass grafts that originate from
the popliteal artery and whose operative indication was limb-threatening
ischemia. DESIGN: Five-year retrospective study with follow-up that ranged
from less than 1 month to 60 months. SETTING: Tertiary care center.
PATIENTS: Twenty-four threatened limbs in 23 patients were reviewed.
Surgical indications included gangrene in 15 limbs (63%), rest pain in
seven limbs (29%), and a nonhealing ulcer in two limbs (8%). Patients with
previous ipsilateral infrainguinal arterial reconstructive procedures were
excluded. Mean patient age was 66 years, and 18 patients 78% had
insulin-dependent diabetes mellitus. MAIN OUTCOME MEASURES: Percentages of
primary graft patency and limb salvage were determined by the life-table
method. Proximal arterial disease progression was assessed via follow-up
arteriography or segmental limb pressures. RESULTS: The cumulative rates of
primary graft patency and limb salvage at 1, 3, and 5 years were 73%, 59%
and 59%, and 87%, 57%, and 57%, respectively. No patient developed proximal
arterial disease progression that required intervention during the study
period. CONCLUSIONS: The cumulative rates of primary graft patency and limb
salvage were essentially the same, which indicated poorly collateralized
limbs that are solely dependent on the graft. There did not appear to be a
critical progression of proximal arterial disease that would warrant a more
proximal graft origin. A short autologous saphenous vein graft that
originates from the above-knee or below-knee popliteal artery is a durable
bypass.
