Isolated popliteal artery: results of surgical treatment and causes of failure

Isolated popliteal artery is defined as an obstruction of a superficial fem oral artery with a patent popliteal segment followed by an obstructed dista l popliteal artery or a patent leg artery less than 5 cm long. Purpose: The aim of this retrospective study was to report the results of s urgical treatment and the causes of failures. Patients and methods: From 1988 to 1996, 31 patients with isolated poplitea l artery were operated on with femoropopliteal bypass. The age of the patie nts ranged from 45 to 92 years, (mean: 79 years); all had critical ischemia that threatened limb viability. All underwent preoperative arteriography a nd diagnosis was confirmed by intraoperative arteriography. Results: In the postoperative course, there were 22 patent bypasses (68%) w ith minor amputation in five patients, and nine thromboses that required a major amputation in seven patients, a trans-metatarsal amputation in one, a nd a medical treatment in one. With a mean 37-month follow-up, seven thromb oses required a major amputation in five patients, a new bypass in one and a medical treatment in one. The death rate was 34% at two years. The actuar ial patency rates of the bypasses were 51% at one year, 38% at two years an d 25% at five years. The limb salvage rate was identical. The patency rates were 65% at one, two and five years for venous bypasses and 38%, 13% and 0 % respectively for PTFE bypasses. Statistical analysis showed two causes of failure: the absence of a run-off branch and the use of PTFE prostheses. N o other statistically significant cause of failure was demonstrated among t hose analysed. Favourable anatomic conditions for a bypass to a leg artery were not predictive of failure of a femoro-popliteal bypass on the isolated arterial segment. Conclusion: Bypass to isolated popliteal artery is indicated in patients wh ose limb viability is jeopardized. Results may be considered as satisfactor y especially if there is a run-off branch and if a venous graft is availabl e for the bypass. (C) 2000 Editions scientifiques et medicales Elsevier SAS .