Jl. Mills et al., THE UTILITY AND DURABILITY OF VEIN BYPASS GRAFTS ORIGINATING FROM THEPOPLITEAL ARTERY FOR LIMB SALVAGE, The American journal of surgery, 168(6), 1994, pp. 646-651
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.