Relationship of femorodistal bypass patency to clinical outcome

Objective: to investigate the relationship between bypass patency, limb sur vival and clinical symptoms after femorodistal bypass procedures. Design: multicentre, prospectively planned 12-month postoperative follow-up . Patients and methods: five hundred and seventeen patients undergoing femoro distal bypass surgery for severe ischaemia. Clinical symptoms, bypass paten cy were recorded at regular intervals up to 12 months postoperatively. Results: complete follow-up data was obtained on 498 patients (96%). Fifty- six (17%) of the 341 patients with patent bypasses had either rest pain or ulcers of had undergone major amputation at 12 months. Of the 167 patients with an occluded bypass, 22 patients (13%) had improved clinical symptoms a nd a total of 59 patients (35%) had avoided major amputation at 12 months. The clinical outcome for patients classified preoperatively as Fontaine sta ge IV was significantly worse than for those in stage III preoperatively de spite similar bypass patency rates. Conclusions: there is a fair correlation between technical and clinical out come after femorodistal bypass surgery at 12 months, brit there are signifi cant numbers of patients with occluded bypasses who have a good clinical ou tcome and of patients with patent bypasses who have a poor clinical outcome . The reporting of symptoms in addition to bypass patency would aid the int erpretation of surgical results.