Related Experiment Videos
Femoropopliteal reconstruction for claudication. The risk to life and limb
K C Kent1, M C Donaldson, C E Attinger
1Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Insights
Femoropopliteal bypass grafting for intermittent claudication shows good results. Autogenous vein grafts offer higher patency rates than polytetrafluoroethylene grafts, with similar low risks of death and amputation.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
Background:
- Intermittent claudication is a common symptom of peripheral artery disease.
- Femoropopliteal bypass grafting is a surgical option for severe cases.
Purpose of the Study:
- To evaluate the outcomes of femoropopliteal bypass grafting for disabling intermittent claudication.
- To compare the efficacy of autogenous vein versus polytetrafluoroethylene grafts.
Main Methods:
- Retrospective analysis of 249 femoropopliteal bypass grafts in 191 patients over a decade.
- Indication for surgery was disabling claudication.
- Follow-up included patency rates, operative mortality, and amputation rates.
Main Results:
- Five-year cumulative patency rates were 78% for autogenous vein and 52% for polytetrafluoroethylene grafts.
- Thirty-day operative mortality was 0.8% (2 patients).
- Five-year amputation rate was 2.4% for both graft types.
Conclusions:
- Femoropopliteal reconstruction for claudication is associated with low operative mortality and amputation rates.
- Autogenous vein grafts provide superior long-term patency.
- Prosthetic grafts offer symptomatic relief in about half of patients without increased limb loss risk.
Abstract:
The current study was undertaken to examine the results of femoropopliteal bypass grafting with intermittent claudication as the indication. Of 1173 infrainguinal reconstructions carried out on our service during the past decade, 249 (21%) consecutive femoropopliteal grafts were performed for disabling claudication in 191 patients. The primary five-year cumulative patency rates were 78% for autogenous vein and 52% for polytetrafluoroethylene grafts. There were two (0.8%) 30-day operative deaths and a subsequent five-year amputation rate of 2.4% for both groups. Femoropopliteal reconstruction for claudication may therefore be carried out with acceptably low operative mortality and a subsequent amputation rate comparable with that anticipated from the natural history of the disease. While the five-year patency rate is significantly higher utilizing autogenous vein grafts, symptomatic relief may be expected with prosthetic grafts in approximately half the patients without incurring a higher risk of limb loss.