"Femoro-distal bypass--a worthwhile procedure?"

Infrapopliteal vascular reconstruction was undertaken in 63 patients with limb threatening ischaemia. Graft materials used were reversed autogenous saphenous vein in 33 patients, umbilical vein in 23 patients, composites of saphenous and umbilical vein in six patients, and a Solcograft in one patient. At the end of the first month 13 grafts were non-functioning, and eight of these patients had an amputation performed. Cumulative 3-year limb salvage and patency rates were 69% and 35%, respectively. Cumulative patency rates of saphenous and umbilical vein grafts were equal, and neither the indication for operation nor the preoperative ankle-arm pressure index correlated to graft failure. In total, twenty-two major amputations were performed, 16 below or through the knee, and six above-knee. The conclusion is that vascular reconstructive surgery for limb threatening distal disease is a valuable procedure.