ARE FEMORO-INFRAPOPLITEAL BYPASSES WORTHWHILE FOR LIMB SALVAGE

Objective. This study was performed in order to determine if: 1- femor al bypasses ending below the popliteal artery are justified in aged pa tients or in patients with poor general conditions, 2- if the use of p rosthetic material is justified when no vein is available, 3- if reint ervention is beneficial in case of bypass occlusion, Experimental desi gn. Retrospective study of 162 infrapopliteal bypasses followed during 1 to 12 years (mean: 1.5). Setting. Vascular Surgery Department of th e University Hospital Henri Mondor based in a suburb of Paris, France. Patients, All patients who underwent a femoral bypass ending below th e popliteal artery for Limb salvage from January 1984 to December 1995 . Intervention. These bypasses were performed with a vein in 131 cases and with a PTFE graft (with or without distal cuff) in 31 cases. Meas ures. All patients were followed with clinical evaluation and duplex s can. Primary and secondary patency, limb salvage and patient survival were studied, The survival rates at 1 and 5 years were 87+/-3.8% and 6 6+/-9.6% respectively, Preoperative mortality was 7.4%. Renal insuffic iency requiring dialysis, not age over 80, was associated with high pe rioperative mortality. Results. The primary patency rates of the total series at 1 and 5 years were 55 and 35% respectively for the total se ries. For venous bypasses, it was 58 and 37% while for prosthetic bypa sses, it was 49 and 15%, The secondary patency rates at 1 and 5 years were 67 and 46% for the total series. For venous bypasses, it was 70 a nd 49% and for prosthetic bypasses, it was 53 and 21%. Limb salvage ra tes at 1 and 5 years were 65 and 61% for the total series, 73 and 65% for venous bypasses and 48 and 41% for prosthetic bypasses. Conclusion . 1- Femorotibial or peroneal bypasses are worthwhile for limb salvage even in aged patients but renal insufficiency requiring dialysis may justify primary amputation. 2- If no vein can be used, prosthetic or c omposite bypasses should be performed because they are associated with a 41% limb salvage rate at 5 years. 3- If thrombosis occurs, the incr ease of patency after re-operation is 12% in case of venous bypass and 6% in case of prosthetic bypass.