DURABILITY OF SHORT BYPASSES TO INFRAGENICULAR ARTERIES

Objectives: The purpose was to test the durability of the use of the u nobstructed popliteal or tibial arteries as alternative inflow sources . Materials: We examined 106 such bypasses performed during a 12 year period (1981-93). The indication for surgery was limb salvage in 99.1% . Seventy-five percent of the patients were male, 78% were diabetic an d the average age was 59.6 years. The inflow source was the above-knee popliteal artery in 15 cases, the below-knee popliteal artery in 70 c ases, the anterior tibial artery in 11 cases and the posterior tibial artery in 10 cases. Adequacy of inflow uas determined by angiogram as well as ingtraoperative pressure measurement when indicated. Outflow w as to a distal tibial or plantar arteries in 77.4% of the procedures. Forty-six bypasses were performed by an in situ technique. Excised vei n was used as conduit in 60 patients (56.6%); greater saphenous vein ( 38), lesser saphenous vein (10), cephalic/basilic vein (4), and splice d vein (8). Results: Operative mortality was 2.8%. Five year cumulativ e primary patency tons 75.4% with a secondary patency of 82.6%. Five y ear cumulative limb salvage was 93.5%. Patency rate was not significan tly different for various inflows or outflows. Only four of the 106 by passes ultimately required a reconstruction from the femoral level for proximal progression of disease. Bypasses performed using an in situ technique showed a significantly better 5 year cumulative secondary pa tency rate (96.3%) than those done with excised vein (70.5%), p < .05. Conclusion: Results of this study indicate that use of the popliteal or tibial arteries as an inflow source in the absence of significant p roximal disease carries acceptable results, especially when using the vein in situ.