Further experience with an all-autogenous tissue policy for infrainguinal reconstruction

Abstract

Between 1985 and 1991 a policy of strong preference for autogenous methods of infrainguinal reconstruction was followed to assess the efficacy of this strategy. A total of 585 autogenous infrainguinal reconstructions were performed on 537 limbs in 448 patients between 1985 and 1991. Thirty-eight additional revascularizations were performed with prosthetic materials and seven patients underwent primary amputation during this interval. Of the autogenous reconstructions, 74% were primary and 26% were secondary procedures, 71% were for limb salvage, and 48% were to infrapopliteal arteries. Greater saphenous vein was used for 447 bypass grafts. Other autogenous methods included bypass with lesser saphenous (21), arm (20), and composite (30) veins, endarterectomy of the common femoral (18) and superficial femoral (40) arteries, and isolated profundaplasty (9). Major operative morbidity occurred in 41 patients (7%), early graft failure in 47 (8%), and death in 12 (2%). At 5 years, the overall cumulative primary patency rate was 63% and the secondary patency rate was 72%. The 5-year secondary patency rate for the subgroup in which greater saphenous vein was used was 79% and for alternative autogenous methods the rate was 49% (p < 0.001). During the period of follow-up, major amputation was performed in 45 (7.9%) of the operated limbs. This experience supports continued preferential use of autogenous methods for infrainguinal reconstruction.