title: The popliteal artery as inflow for distal bypass grafting.
abstract: OBJECTIVE
  To examine the patency and limb salvage characteristics of the popliteal-distal artery saphenous-vein bypass in patients with minimal superficial femoral artery disease.
  
  
  METHODS
  A retrospective review.
  
  
  METHODS
  A tertiary care university hospital in the Chicago, Ill, metropolitan area.
  
  
  METHODS
  Fifty-two popliteal-distal artery saphenous-vein bypasses for occlusive disease were performed in 51 patients between 1980 and 1993. The mean age at operation was 62 years (range, 37 to 85 years); 34 patients (67%) were male, 45 (88%) were smokers, 44 (86%) had diabetes, and 34 (67%) had coronary disease. The primary indications for operation were gangrene (21 patients [41%]), ulcer (15 patients [29%]), and rest pain (16 patients [31%]).
  
  
  METHODS
  Bypass of diseased arterial segments was performed using popliteal-distal artery saphenous-vein bypass grafts. The proximal anastomoses were either to the above-knee popliteal artery (50%) or to the below-knee artery (50%), with outflow to tibial (79%) or pedal vessels (21%).
  
  
  METHODS
  Overall patient survival, limb salvage, and primary and secondary graft patency.
  
  
  RESULTS
  Follow-up of graft patency ranged from 1 day to 11 years (mean follow-up, 2.7 years). The perioperative mortality was 2% and life-table survival was 94% at 1 year, 68% at 5 years, and 50% at 10 years. Primary patency was 90% at 1 month, 82% at 1 year, and 75% at 5 years. There were 14 primary graft failures, only two of which could be traced to progression of proximal disease; five failures occurred less than 30 days after operation. Six of these 14 patients contributed to secondary patency that was 96% at 1 month, 90% at 1 year, and 79% at 5 years. Limb salvage was 96% at 1 month, 90% at 1 year, and 87% at 5 years (seven major amputations were required). No significant differences in patency, limb salvage, or survival were observed on comparison of the level of the proximal or distal anastomosis, type of vein graft, or presence of comorbidities.
  
  
  CONCLUSIONS
  We conclude that popliteal-distal artery bypass provides excellent patency and limb salvage for patients with severe ischemia. The use of a popliteal artery inflow source is preferable in patients with a paucity of venous segments since progression of proximal disease rarely leads to graft failure.
authors.affiliation: Division of Vascular Surgery, Northwestern Memorial Hospital, Chicago, Ill.
authors.forename: P S
authors.initials: PS
authors.lastname: Brown
authors.forename: W J
authors.initials: WJ
authors.lastname: McCarthy
authors.forename: J S
authors.initials: JS
authors.lastname: Yao
authors.forename: W H
authors.initials: WH
authors.lastname: Pearce
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005734:Gangrene / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007871:Leg Ulcer / Q000453:epidemiology / Q000209:etiology; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D011150:Popliteal Artery / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D012501:Saphenous Vein / Q000601:surgery*; D012907:Smoking / Q000453:epidemiology; D015996:Survival Rate; D017211:Treatment Failure; D014654:Vascular Patency