Femoropopliteal Bypasses to Isolated Popliteal Artery Segments: PTFE vs. Vein Grafts

Abstract

A 10-year experience of 217 femoropopliteal bypasses (FPBs) to isolated popliteal artery (IPA) segments in 207 patients is reported. Thirty-three FPBs (15%) were performed with reversed saphenous vein (RSV) and 184 (85%) with polytetrafluoroethylene (PTFE) grafts. Operative indications were gangrene in 121 (56%), nonhealing ulceration in 40 (18%), ischemic rest pain in 51 (24%), and claudication in 5 (2%) cases. The 5-year primary graft patency rate of these bypasses was 59% (RSV = 74%, PTFE = 55%; p <0.05), the secondary 5-year graft patency rate was 61% (RSV = 79%, PTFE = 56%; p <0.05), and the 5-year limb salvage rate was 78% (RSV = 78%, PTFE = 78%). The 30-day operative mortality rate was 10% and the 5-year patient survival rate was 38%. Eleven patients (5%) required lower extremity amputation because of progressive gangrene or extensive infection despite a patent bypass to an IPA segment. Amputation was avoided in 23 patients (11%) by reoperation and secondary graft extension to an infrapopliteal artery with RSV. FPB to an IPA segment combined with graft extension to an infrapopliteal artery with RSV was performed as primary therapy in 19 (9%) patients because of extensive pedal necrosis or infection. We conclude that FPBs to IPA segments: 1) have acceptable 5-year graft patency and limb salvage rates; 2) should be performed with RSV grafts when possible; 3) may be performed with PTFE grafts if necessary, with a resulting limb salvage rate equal to that of RSV grafts; and 4) require sequential extension to an infrapopliteal artery when foot necrosis or infection is extensive. In addition, the presence of an IPA segment is associated with a high operative mortality rate and limited life expectancy due to coronary artery disease.