Endarterectomy versus vein bypass grafts in femoropopliteal occlusions (author's transl)

Abstract

On the basis of our experience with 1827 femoropopliteal arterial reconstructions performed from 1959 through 1974 we have worked up a system of strict guidelines for the choice of procedure. The vein bypass is the method of choice in all cases at stages III/IV (i.e. resting pain or gangrene), in lengthy occlusions of the femoral arteries continuing into the distal popliteal arteries or in stenotic lesions or occlusions of the tibial arteries, in all recurrent occlusions, and in cases with calcification or dilatation of the arterial wall. The indication for endarterectomy is restricted to stage II (i.e. intermittent claudication) and to segmental occlusions of the femoral or popliteal arteries as well as transitional or lengthy occlusions of the femoral artery continuing to the proximal popliteal artery. Under these guidelines a total group of 645 patients underwent 721 femoropopliteal reconstructions-307 endarterectomies and 414 vein grafts-from 1971 through 1974. The average age of the patients was 60 years. In 50% of all cases operations were carried out for advanced ischemia treatening the extremity. For all the series the patency rate of vein bypass was 79% and of endarterectomy 71%. Accumulative patency rates by the life table method according to the preoperative degree of arterial insufficiency and the postoperative follow up period of 4 years do not show statistically significant differences between both procedures under the given guidelines.