POPLITEAL-TO-DISTAL BYPASS GRAFTS FOR LIMB SALVAGE

From July 1989 to July 1994, a total of 44 popliteal-to-distal artery bypasses were performed in 36 patients (29 men and seven women, mean a ge 62 +/- 10 years). These procedures accounted for 8.8% of all infrai nguinal revascularizations performed during that period. Risk factors included diabetes in 33 patients (92%), smoking in 18 (50%), and coron ary artery disease in 15 (42%). Prior to revascularization all patient s were at risk of limb loss. Tissue necrosis was present in 31 cases ( 71%), ulceration in eight cases (18%), and rest pain in five cases (11 %). Patency of the femoral and popliteal arteries was confirmed prior to surgery in all cases. Intraoperative percutaneous angioplasty of th e superficial femoral artery was performed in three cases. Proximal an astomosis was made to the distal popliteal artery in all cases. A tota l of 52 distal anastomoses (eight sequential bypasses) were made on th e following arteries: posterior tibial artery in 13 cases, anterior ti bial artery in eight cases, peroneal artery in six cases, plantar arte ry in two cases, and dorsalis pedis artery in 21 cases. The greater sa phenous vein was used as graft material in 42 cases (95%) and the less er saphenous vein in two cases (5%). No patient died during hospitaliz ation. Early bypass occlusion occurred in three cases (6.8%) and led t o amputation in all cases. Secondary patency and limb salvage rates at 3 years calculated using the actuarial method were 74% and 82% respec tively. Bypass thrombosis due to superficial femoral artery deteriorat ion was not observed in any case. The present study indicates that pop liteal-to-distal artery bypass is a simple, durable, and low-risk meth od of lower limb revascularization. Medium-term results are promising and support routine use of popliteal-to-distal artery bypass for limb salvage in patients without significant stenosis of the superficial fe moral artery.