LONG OCCLUSION OF THE SUPERFICIAL FEMORAL -ARTERY - VENOUS GRAFT

In long occlusions of the superficial femoral artery, possibilities of revascularization depend on the patency of the above-knee popliteal a rtery. In case of occlusion of the above-knee popliteal artery, the di stal anastomosis is to be performed at the below-knee level or more di stally; in this situation, studies demonstrate a clearcut superiority of venous bypasses over prosthetic bypasses. Patency of the above-knee popliteal artery allows to perform a shorter bypass avoiding to cross the knee joint; given comparable results between venous and prostheti c above-knee bypasses in certain series, several authors advocated the preferential, if not systematic use of prosthetic materials at this l evel; this attitude having the advantage of preserving the saphenous v ein for later coronary or distal grafting. A critical analysis of stud ies advocating this therapeutic option reveals that results of prosthe tic and venous above-knee bypasses are equivalent in only very restric tive clinical situations (claudication, good runoff) and for follow up less than 3 years; beyond this follow up, the use of a prosthesis inc reases the number of secondary procedures necessary for maintaining or restoring patency and for this reason increases slightly the overall mortality owing to the operative mortality associated with each reoper ation. Apart from rare cases represented by fragile and high-risk pati ents, whose lifespan is likely to be short and in whom a quicker opera tion is advisable, indications of the use of prosthetic grafts depend on the limits of the use of the saphenous vein generated by a poor qua lity or an insufficient diameter