Autologous saphenous vein popliteal-tibial artery bypass for limb-threatening ischemia : a reassessment

BACKGROUND : The purpose of this review was to ascertain the cumulative primary and secondary graft patency rates, the cumulative limb salvage rate, and the frequency of atherosclerotic disease progression proximal to the graft origin, in patients with autologous saphenous vein popliteal-tibial artery bypass grafts whose operative indication was limb-threatening ischemia. PATIENTS AND METHODS : Forty-three short autologous saphenous vein grafts originating from the popliteal artery were retrospectively reviewed. The life-table method was used to determine primary and secondary graft patency and limb salvage rates. Atherosclerotic disease progression proximal to the graft origin was assessed via follow-up arteriography, segmental limb pressures, or pulse-volume recordings. All other data were compared by chi-square analysis. RESULTS : The cumulative primary graft patency rate at 1, 3, and 5 years (86%, 66%, 58%) was similar to the cumulative secondary patency rate (90%, 70%, 62%) and the cumulative limb salvage rate (80%, 55%, 55%). No patient developed hemodynamically significant atherosclerotic disease proximal to the graft origin during the follow-up period. CONCLUSIONS : The similarity of the life-table data suggests graft-dependent, poorly collateralized limbs ; it is therefore not uncommon for these patients to require major amputations shortly after bypass failure. There was no evidence of critical proximal disease progression that might warrant a more proximal graft origin. Popliteal-tibial artery bypass grafts are durable, with acceptable graft patency and limb salvage rates.