title: Is infrapopliteal bypass compromised by distal origin of the proximal anastomosis?
abstract: Distal origination of the proximal anastomosis (DOPA) of an infrapopliteal bypass beyond the adductor hiatus minimizes the length of graft required and optimizes use of scarce autogenous conduit. Sixty-two DOPA infrapopliteal revascularizations using autogenous vein performed for limb salvage over a 7-year period were reviewed and compared with 203 concurrent infrapopliteal bypasses originating more proximally (POPA). Life-table analysis revealed no difference at 54 months between DOPA and POPA bypass with regard to primary patency (57% vs. 50%, respectively) or secondary patency (67% vs. 65%, respectively). Differences in limb salvage at 54 months between DOPA and POPA bypasses did not reach statistical significance (53% vs. 66%, p = 0.12), although DOPA fared worse. Inferior limb salvage results in all infrapopliteal bypasses were correlated with the presence of tissue necrosis (52% vs. 70%, p < 0.001), which was more prevalent in patients undergoing DOPA bypass (71% vs. 49%, p < 0.01). The long-term patency of infrapopliteal bypass appears only marginally affected by DOPA. However, the prognosis for limb salvage in this setting is compromised as a result of the virulent behavior of the atherosclerotic disease that spares the superficial femoral artery while predominantly involving the popliteal and tibial vessels.
authors.affiliation: Medical University of South Carolina, Charleston, USA.
authors.forename: T E
authors.initials: TE
authors.lastname: Brothers
authors.forename: J G
authors.initials: JG
authors.lastname: Robison
authors.forename: B M
authors.initials: BM
authors.lastname: Elliott
authors.forename: C
authors.initials: C
authors.lastname: Arens
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011150:Popliteal Artery / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation