OUTCOME OF INFRAINGUINAL ARTERIAL BYPASS-GRAFTING IN LIMBS WITH POSTTHROMBOTIC SYNDROME

From among 336 infrainguinal bypass procedures performed for treatment of atherosclerotic occlusive disease, 27 patients with histories of d eep venous thrombosis (DVT) were retrospectively analyzed with regard to patency and limb salvage rates. In 25 patients, venous diagnosis wa s verified by antegrade phlebography, which demonstrated postthromboti c changes in the deep venous system. Indications for infrainguinal byp ass surgery were severe claudication (six patients), rest pain (nine p atients), and nonhealing ulcer or gangrene (12 patients). Sixteen auto logous saphenous vein grafts, six composite (PTFE-vein), and five pros thetic grafts were used. All 11 femorodistal bypass grafts occluded wi thin 6 months compared to an 82% patency rate of femoropopliteal bypas ses. Among 16 femoropopliteal by passes, only one patient with poor ru noff underwent lower leg amputation after bypass failure. On the other hand, all It patients with distal bypass underwent major amputation d uring the first 7 months. The dismal outcome of patients with previous DVT undergoing femorodistal bypass procedures in this small populatio n might be due to the deleterious effect of distal runoff status due t o severe atherosclerotic changes.