Secondary femoral-distal bypass.
Thirty-nine secondary femoral-distal (femorotibial and femoroperoneal) bypasses were reviewed and compared to 89 primary femoral-distal bypasses (done during the same time period) to investigate the efficacy of secondary femoral-distal bypass. Graft patency at 2 years by life table analysis was similar in both groups (38% primary group vs 36% secondary group). However, limb salvage was significantly less in the secondary group (52% vs 68% at 2 years, p less than 0.05). This decrease was primarily due to poorer limb salvage using composite grafts (prosthetic/vein) compared to vein grafts in patients who underwent secondary femoral-distal bypasses (37% vs 76% at 2 years, p less than 0.05). Postoperative wound infections and mortality were similar in both groups. Thus, femoral-distal bypass after failure of a previous infrainguinal reconstruction offers good long-term limb salvage with acceptable surgical risk when autologous vein is available for use as the arterial conduit.
Silverman
S H
SH
Department of Surgery, University of Florida, Gainesville.
Flynn
T C
TC
Seeger
J M
JM
D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001807:Blood Vessel Prosthesis; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D015993:Life Tables; D016016:Proportional Hazards Models; D012086:Reoperation; D012307:Risk Factors; D012501:Saphenous Vein / Q000601:surgery*; D014654:Vascular Patency