title: Ten years after arterial bypass surgery for claudication: venous bypass is the primary procedure for TASC C and D lesions.
abstract: BACKGROUND
  The appropriate role for surgery and endovascular therapy for severe intermittent claudication (IC) remains controversial. We present our results after infrainguinal autogenous bypass for severe IC more than 10 years ago giving a reasoned argument to perform vein bypass as the primary procedure for severe IC.
  
  
  METHODS
  Our prospectively designed database includes more than 1,000 infrainguinal bypasses following an all-autogenous policy. For this review only patients operated on for severe IC at least 10 years ago were included. The primary end points were survival and primary and assisted-primary patency rates.
  
  
  RESULTS
  From October 1988 until December 2000, 124 bypasses for IC were performed. Ninety-five patients were male and the mean age was 64.5 ± 10.8 years. Survival after 10 years was 50.3% according to life table analysis. Forty bypasses were to the supragenicular artery, 62 to the infragenicular popliteal artery, and 22 to the tibial artery. Thirty-day mortality was 0.8% (1 patient). The primary patency rate after 10 years was 63.5% and the assisted-primary patency rate 87.3%.
  
  
  CONCLUSIONS
  Infrainguinal venous bypass for severe IC has excellent long-term results. Our results are strong arguments against the liberal use of stenting long lesions of the femoropopliteal artery. Venous bypass remains the primary procedure for TASC C and D lesions in claudicants.
authors.affiliation: Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland. teugster@uhbs.ch
authors.forename: Thomas
authors.initials: T
authors.lastname: Eugster
authors.forename: Regula
authors.initials: R
authors.lastname: Marti
authors.forename: Lorenz
authors.initials: L
authors.lastname: Gurke
authors.forename: Peter
authors.initials: P
authors.lastname: Stierli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000379:methods