THE POPLITEAL ARTERY AS INFLOW FOR DISTAL BYPASS-GRAFTING

Objective: To examine the patency and limb salvage characteristics of the popliteal-distal artery saphenous-vein bypass in patients with min imal superficial femoral artery disease. Design: A retrospective revie w. Setting: A tertiary care university hospital in the Chicago, Ill, m etropolitan area. Patients: Fity-two popliteal-distal artery saphenous -vein bypasses for occlusive disease were performed in 51 patients bet ween 1980 and 1993. The mean age at operation was 62 years (range, 37 to 85 years); 34 patients (67%) were male, 45 (88%) were smokers, 44 ( 86%) had diabetes, and 34 (67%) had coronary disease. The primary indi cations for operation were gangrene (21 patients [41%]), ulcer (15 pat ients [29%]), and rest pain (16 patients [31%]). Intervention: Bypass of diseased arterial segments was performed using popliteal-distal art ery saphenous-vein bypass grafts. The proximal anastomoses were either to the above-knee popliteal artery (50%) or to the below-knee artery (50%), with outflow to tibial (79%) or pedal vessels (21%). Main Outco me Measures: Overall patient survival, limb salvage, and primary and s econdary graft patency. Results: Follow-up Of graft patency ranged fro m 1 day to 11 years (mean follow-up, 2.7 years). The perioperative mor tality was 2% and life-table survival was 94% at 1 year, 68% at 5 year s, and 50% at 10) ears. Primary patency was 90% at 1 month, 82%, at 1 year, and 75% at 5 years. There were 14 primary graft failures, only t wo of which could be traced to progression of proximal disease; five f ailures occurred less than 30 days after operation. Six of these 14 pa tients contributed to secondary patency that was 96% at 1 month, 90% a t 1 year, and 79% at 5 years. Limb salvage was 90%, at 1 month, 90% at 1 year, and 87% at 5 years (seven major amputations were required), N o significant differences in patency, limb salvage, or survival were o bserved on comparison of the level of the proximal or distal anastomos is, type of vein graft, or presence of comorbidities. Conclusions: We conclude that popliteal-distal artery bypass provides excellent patenc y and limb salvage for patients with severe ischemia. The use of a pop liteal artery inflow source is preferable in patients with a paucity o f venous segments since progression of proximal disease rarely leads t o graft failure.