THE UTILITY AND DURABILITY OF VEIN BYPASS GRAFTS ORIGINATING FROM THEPOPLITEAL ARTERY FOR LIMB SALVAGE

BACKGROUND: Short vein grafts originating from sites distal to the com mon femoral artery have been reported to be useful in selected patient s with tibial artery disease. From 1987 to 1993, we performed 504 cons ecutive infrainguinal vein bypass grafts, of which 56 (11%) originated from the popliteal artery, 25 above and 31 below the knee. PATIENTS A ND METHODS: The patients were 16 women and 37 men, with a mean age of 62.4 years. Eighty-seven percent were diabetic, 57% had clinically obv ious coronary artery disease, and 28% had end-stage renal disease (ESR D). The indication for surgery was ulceration or gangrene in 93% of ca ses. We preferentially used reversed greater saphenous vein harvested from the thigh to optimize conduit quality and avoid lower leg wound c omplications. The outflow artery sites were: dorsal pedal (17), poster ior tibial (14), peroneal (10), anterior tibial (8), lateral or medial plantar (5), and sequential tibial (2). All patients were followed po stoperatively with serial duplex surveillance. The mean follow-up was 12.5 months (range 1 to 66). RESULTS: In-hospital mortality was 5.4%. Mortality at 24 months was 19% overall and 38% in patients with ESRD. Limb salvage Tvas 77% at 3 years, 92% in patients with normal renal fu nction versus 59% in those with ESRD (P<0.003). Primary graft patency by life-table analysis was 94% at 1 month and 84% at 3 years. Five pat ients with patent grafts required amputation, 4 early and 1 late. Eigh t months after surgery, 1 patient (1.8%) developed superficial femoral artery stenosis which was diagnosed by duplex surveillance and succes sfully treated by percutaneous transluminal balloon angioplasty. CONCL USIONS: Vein bypass grafts originating from the popliteal artery are e ffective and durable. Proximal disease progression rarely poses a sign ificant threat to long-term graft patency. Patients with ESRD, blind t ibial outflow tracts, and extensive forefoot lesions appear to be at i ncreased risk of limb loss even,vith continued graft patency.