Popliteal and Tibial Artery Bypasses for Limb Salvage

Abstract

This is a report on personal experiences with 549 cases of popliteal and tibial artery revascularization. There were 204 cases of femoral-popliteal artery by pass procedures utilizing vein grafts. In 193 cases, this procedure was done with autogenous greater saphenous vein grafts. The remainder of the cases consisted of arm veins, bank veins and superficial femoral veins. There were 149 femoral- tibial or popliteal-tibial artery bypasses utilizing vein grafts or composite grafts. In 83 cases, tibial artery bypasses were done with autogenous greater saphenous vein grafts. In 30 cases, popliteal-tibial artery bypasses were done with autoge nous greater saphenous vein grafts. In 25 cases, femoral-popliteal-tibial artery sequential bypasses were done with autogenous greater saphenous vein grafts. The remainder were arm veins and composite grafts with arm vein, leg vein and graft materials. In 178 cases, femoral-popliteal or tibial artery bypasses were done with PTFE grafts. Of these cases, 157 femoral-popliteal bypasses were done with PTFE. Femoral-tibial artery bypasses were done with PTFE in 21 cases. In 18 cases, femoral-popliteal artery bypasses were done with biografts, utilizing human umbilical vein grafts. The sexual ratio in the total number of cases was 62% male to 38% female. The total number of cases was further divided into different groups. The cumulative patency rate of femoral-popliteal artery bypass, utilizing PTFE graft with distal anastomosis at above-knee level, was 90% at the third year. The femoral-popliteal artery bypass with autogenous greater saphenous vein graft had a patency rate of 84% at the fifth year. The patency rate of femoral-tibial artery bypass with autogenous greater saphenous vein graft was 68% at the fifth year. The femoral-popliteal-tibial artery sequen tial bypass, with autogenous greater saphenous vein graft, had a third-year patency rate of 80%. The popliteal-distal-tibial artery bypass, with autogenous greater saphenous vein graft, had a patency rate of 70% at the third year. These patients had been faced with major limb loss due to extremely poor distal run- off, and had been offered major amputation at one time. The patency rate of femoral-popliteal artery bypass, utilizing PTFE, combining both above and be low-knee level of distal anastomosis, was 85% at the third year. However, the femoral-tibial artery bypass utilizing PTFE graft had an extremely poor pat ency rate. At the third year, the patency rate was around 20%. The five year patency rate of femoral-popliteal artery bypass with PTFE graft was 75%, if the distal anastomosis was made at the above-knee level. The same graft, at the below-knee level, was 60%. The patency rate in five years was extremely poor for femoral-tibial artery bypass with PTFE graft. The five-year patency rate of femoral-popliteal-tibial artery sequential bypass, with autogenous greater saphenous vein graft, was 70%. The popliteal-distal tibial artery bypass graft, with autogenous greater saphenous vein graft, had a patency rate of 65% at the fifth year. The femoral-popliteal artery bypass with autogenous greater saphe nous vein graft had a patency rate of 70% at the eighth year. The femoral-tibial artery bypass with autogenous greater saphenous vein graft had a patency rate of 60% at the eighth year.