Late results of two hundred seventeen femoropopliteal bypasses to isolated popliteal artery segments.
A 10-year-experience of 217 femoropopliteal bypasses to isolated popliteal artery segments in 207 patients is reported. Thirty-three femoropopliteal bypasses (15%) were performed with reversed saphenous vein and 184 (85%) with polytetrafluoroethylene grafts. Operative indications were gangrene in 121 (56%), nonhealing ulceration in 40 (18%), ischemic rest pain in 51 (24%), and claudication in 5 (2%) cases. The 5-year primary graft patency rate of these bypasses was 59% (reversed saphenous vein, 74%; polytetrafluoroethylene, 55%; p less than 0.05), the secondary 5-year graft patency rate was 61% (reversed saphenous vein, 79%; polytetrafluoroethylene, 56%; p less than 0.05), and the 5-year limb salvage rate was 78% (reversed saphenous vein, 78%; polytetrafluoroethylene, 78%). The 30-day operative mortality rate was 10%, and the 5-year patient survival rate was 38%. Eleven patients (5%) required lower extremity amputation because of progressive gangrene or extensive infection despite a patent bypass to an isolated popliteal artery segment. We conclude that femoropopliteal bypasses to isolated popliteal artery segments (1) have acceptable 5-year graft patency and limb salvage rates; (2) should be performed with reversed saphenous vein grafts when possible; (3) may be performed with polytetrafluoroethylene grafts if necessary, with a resulting limb salvage rate equal to that of reversed saphenous vein grafts; and (4) require sequential extension to an infrapopliteal artery in up to 20% of patients. In addition, the presence of an isolated popliteal artery segment is associated with a high operative mortality rate and limited life expectancy because of coronary artery disease.
Kram
H B
HB
Division of Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, N.Y. 10467.
Gupta
S K
SK
Veith
F J
FJ
Wengerter
K R
KR
Panetta
T F
TF
Nwosisi
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005734:Gangrene / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007717:Knee / Q000098:blood supply; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011138:Polytetrafluoroethylene; D011150:Popliteal Artery / Q000601:surgery*; D011182:Postoperative Care; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation; D015996:Survival Rate; D014654:Vascular Patency
D011138:Polytetrafluoroethylene