AUTOLOGOUS SAPHENOUS-VEIN POPLITEAL-TIBIAL ARTERY BYPASS FOR LIMB-THREATENING ISCHEMIA - A REASSESSMENT

BACKGROUND: The purpose of this review was to ascertain the cumulative primary and secondary graft patency rates, the cumulative limb salvag e rate, and the frequency of atherosclerotic disease progression proxi mal to the graft origin, in patients with autologous saphenous vein po pliteal-tibial artery bypass grafts whose operative indication was lim b-threatening ischemia, PATIENTS AND METHODS: Forty-three shout autolo gous saphenous vein grafts originating from the popliteal artery were retrospectively reviewed, The life-table method was used to determine primary and secondary graft patency and limb salvage rates, Atheroscle rotic disease progression proximal to the graft origin was assessed vi a follow-up arteriography, segmental limb pressures, or pulse-volume r ecordings, All other data were compared by chi-squaue analysis, RESULT S: The cumulative primary graft patency rate at 1, 3, and 5 years (86% , 66%, 58%) was similar to the cumulative secondary patency rate (90%, 70%, 62%) and the cumulative limb salvage rate (80%, 55%, 55%), No pa tient developed hemodynamically significant atherosclerotic disease pr oximal to the graft origin during the follow-up period, CONCLUSIONS: T he similarity of the life-table data suggests graft-dependent, poorly collateralized limbs; it is therefore not uncommon for these patients to require major amputations shortly after bypass failure, There was n o evidence of critical proximal disease progression that might warrant a more proximal graft origin, Popliteal-tibial artery bypass grafts a re durable, with acceptable graft patency and limb salvage rates.