[Repeated subinguinal bypass. Report of 85 cases]

From 1975 to 1987, 68 patients were operated with repeated subinguinal bypass (SIB) following early or late thrombosis os an initial bypass graft; 10 were operated with a third SIB, 4 with a fourth SIB. The indication for the second SIB was acute ischemia in 15 cases and chronic ischemia in 53. The graft material used was venous in 21 cases, prosthetic in 29 cases and mixed in 53. The distal anastomosis was performed on the upper popliteal artery in 12 cases, the lower popliteal artery in 34 cases or an artery in leg in 22 cases. The actuarial permeability rate of 84 repeated SIBs, whatever the material, was 21.7% at 1 year (50.2% for venous grafts and 13.6% for prosthetic grafts). The limb preservation rate was 47.9% at 5 years. Operative mortality was about 1%. The analysis of the results suggests that the repeated SIB should be performed only: for limb salvage, if the downstream arterial bed is in good condition, with usable venous material. The risk of having to perform a thigh amputation rather than a leg amputation when attempting repeated SIB is of 13.9% only.