Femoropopliteal bypass for chronic lower limb ischemia: A prospective cohort study and single center cases series

Abstract

BackgroundPeripheral occlusive arterial disease (POAD) is a steadily increasing global epidemic. Femoropopliteal bypass (FPB) is the traditional therapeutic option whenever endovascular treatments failed or not indicated. We present our experience in lower limb revascularization. Patients and methodsProspective observational cohort single center study included 158 patients with intermittent claudication (IC) or critical limb ischemia (CLI). The patients were placed in 7 Rutherford categories & their angiographic findings were graded according to Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) criteria. The ipsilateral great saphenous vein was used for revascularization. Resultsmale patients were 113 (71.5%); female were 45 (28.5%). Age ranged from 39 to 77 years, with a mean of 60.7 ± 7.8 years. About 79.1% of patients were in the 6th & 7th decades. Only 26 patients (16.5%) had severe IC & 83.5% had CLI. Almost all patients with Rutherford category 3–6 had an ankle brachial index (ABI) less than 0.70. Most Femoropopliteal lesions (n = 115, 72.8%)near half infrapopliteal lesions (n = 74, 46.8%) were of TASC II B & C types. Majority of patients received a vein graft. Distally, 100 grafts (66.7%) were sutured below the knees whereas the remainder were either behind (n = 31) or above the knees (n = 8). The follow up ranged from 1 month to 11 years. One & 5 year patency rates of vein grafts were 88.7% & 70.2% respectively. ConclusionsFPB using saphenous graft yield a very good graft patency, low rates of amputation, morbidity and mortality. Long-term patency is excellent.