Factors affecting the outcome of 463 femorotibial reconstructions

Between 1973 and 1986, 463 infrapopliteal bypasses were performed on 408 limbs in 383 patients at Royal Prince Alfred Hospital. There were 265 males and 118 females. Their mean age was 69 years, 30% were diabetic, 71% smoked and 38% were hypertensive. The indication for surgery was threatened limb loss in 350 limbs and short distance claudication in 58 limbs. The peri-operative mortality rate was 5%. Cumulative graft patency was 58% (s.e.m. = 2.7) at 5 years. The limb salvage rate was 66% (s.e.m. = 2.5) at 5 years. Cumulative patency rate for autogenous grafts (n = 332) was 63% (s.e.m. = 3.2) at 5 years compared with the cumulative patency rate for synthetic grafts (n = 131) of only 38% (s.e.m. = 5) at 5 years (P less than 0.05). There was no significant difference between the cumulative patency of autogenous grafts originating from the common femoral artery (n = 195) and those from the superficial femoral artery (n = 111). Cumulative patency of autogenous grafts did not significantly differ with the site of distal anastomosis; posterior tibial (n = 79), anterior tibial (n = 98), peroneal artery (n = 138) with 5-year cumulative patency rates of 65% (s.e.m. = 6.4), 65% (s.e.m. = 6.1) and 70% (s.e.m. = 4.6) respectively (P greater than 0.05). Autogenous graft material is the most important determinant of a durable result from femorotibial bypass. Proximal and distal anastomotic sites should be chosen to allow maximal utilization of available autogenous vein.