Secondary distal extension of infrainguinal bypass: long-term limb and patient survival

The potential benefits of secondary distal extension vein grafts required after failing or failed initial infrainguinal bypasses were evaluated. Outcomes of secondary distal extension bypass procedures (n = 58) performed between July 1983 and March 1993 were reviewed. Patients (n = 51) had critical ischemia or tissue loss, with an average of 2.8 previous vascular procedures. The 58 initial infrainguinal bypasses included 38 above-the-knee and 13 below-the-knee femoropopliteal, 5 femorodistal, and 2 popliteal-distal. Thirty-nine of the 58 femoropopliteal grafts were prosthetic. The extension bypasses included popliteal-tibial, graft-tibial, and peroneal-plantar. They were performed for recurrent or persistent ischemia after failed initial infrainguinal bypasses in limbs, and with still-patent bypasses. All extension bypasses were vein conduits. Mean follow-up was 59 (range: 6 to 164) months. The cumulative life-table 5-year survival rate for all patients was 95%. The 27-month limb-salvage rate was 70%. Our findings indicate that patients with advanced peripheral vascular disease may have prolonged survival, and extension bypasses contribute significantly to their limb salvage. Thus, aggressive application of extension bypass to save threatened limbs is supported.