Results of prosthetic-vein composite graft with remote popliteal arteriovenous fistula in infragenicular bypass.
OBJECTIVE
The purpose of this study is to report the results of a novel procedure for femoral-distal bypass grafting using a composite graft with an adjunctive remote popliteal fistula distal to the prosthetic portion of the graft. This reconstruction was developed for use in limb salvage in the absence of satisfactory autogenous vein.


METHODS
Data were collected prospectively on all patients undergoing this procedure from January 1, 1993 to December 31, 1999. Graft patency was determined from follow-up duplex scanning. Patient survival was determined by clinic follow-up.


RESULTS
A total of 43 procedures were performed in 38 patients. In 34 patients, 72 previous arterial operations had been previously performed on the ipsilateral limbs. There were 20 men and 18 women with a mean age of 72 years. The indication for surgery was limb salvage in all, with rest pain in 30, and tissue loss in 13. The outflow artery was the below-knee popliteal artery in 10 and a tibial artery in the remainder. Operative mortality was 6.8%. Mean follow up was 26.9 months. The primary patency was 54% at 12 months. Six reconstructions were revised for a primary assisted patency of 60% at 16 months. Secondary patency was 69% at 16 months. Patient survival was 62% at 2 years and 26% at 5 years.


CONCLUSIONS
The technique of composite grafting with remote popliteal arteriovenous fistula may be a useful alternative in infragenicular bypass when a satisfactory autogenous vein is not available.
Palerme
L P
LP
Department of Surgery, St. Paul's Hospital, University of British Columbia, Canada.
Reid
John D S
JD
Chan
Arthur M T
AM
Lokanathan
Ramesh
R
Macdonald
Shaun
S
Sladen
Joseph G
JG
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D011150:Popliteal Artery / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods*