Tibial bypass using complex autologous conduit: Patency and limb salvage

Over an 8-year period, we performed 93 lower extremity bypasses using compl ex autologous conduits, which included (1) contralateral greater saphenous vein (GSV), (2) composite GSV, (3) superficial femoral vein, (4) lesser sap henous vein, (5) cephalic or basilic veins, and (6) composite-sequential (P TFE and vein) grafts. These grafts represented 16% of all infrainguinal byp asses during this period, and all grafts were performed to treat limb-threa tening ischemia. Survival, patency, and limb salvage were examined by the l ife-table method. Primary graft patency was 46 and 38% at 3 and 5 years. As sisted-primary patency was 62 and 59%, and secondary graft patency rates we re 68 and 64% at 3 and 5 years. Twenty-nine bypasses (31%) required revisio n to restore or maintain patency. The 3-year limb salvage rate was signific antly better when revision was performed for graft stenosis than for graft thrombosis (90% vs. 46%, p <0.05). Overall limb salvage rate was 73% at 5 y ears. The mortality rate was 5.4% and the 5-year survival was 51%. Complex autologous tibial bypasses provided acceptable long-term limb salvage in pa tients with severe ischemia and inadequate ipsilateral GSV. The increased o perating time and complexity required did not produce prohibitive operative risks. Postoperative graft surveillance in these complex vein bypasses all owed revision in many cases before graft occlusion occurred and significant ly improved long-term limb salvage.