Femoropopliteal graft failures. Clinical consequences and success of secondary reconstructions.
We examined 188 failed femoropopliteal grafts during a 16-year period to evaluate the clinical consequences of graft failure and success of secondary revascularization procedures. In limbs with grafts placed for claudication, conditions of 9% with failed grafts remained improved despite graft occlusion, 67% returned to preoperative status, and 24% showed worsened ischemia. One third of claudicants with failed grafts underwent secondary procedures. Ultimately, only 7% of failed grafts in claudicants resulted in amputation, and overall risk of limb loss in patients undergoing operation for claudication alone was low (2%). After failure of grafts performed for limb-salvage indications, 21% of limbs were still improved, and 79% reverted to limb-threatened status, more than half of the limbs undergoing subsequent reoperation. Overall, secondary attempts at reconstruction appeared justified. Although the five-year patency rate of such grafts was only 31%, limb salvage was achieved in 52%, with relatively low morbidity and mortality.
D000368:Aged; D000671:Amputation, Surgical; D001705:Bioprosthesis / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery*; D007866:Leg / Q000098:blood supply; D008297:Male; D011150:Popliteal Artery / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012306:Risk; D012501:Saphenous Vein / Q000637:transplantation; D013997:Time Factors