Reconstructive vascular surgery below the knee

In a series of 38 consecutive patients with advanced peripheral vascular disease (i.e. rest pain) reconstructive vascular surgery was performed with the distal anastomosis below the knee. Ankle/arm pressure index (AAI) was 0.28 (0.11-0.47) preoperatively; accumulated graft patency rate was 0.47 (SD = 0.08) after one year, after three years 0.22 (SD = 0.08). At follow-up (June 83) 34 patients were still alive, 11 patients with patent grafts and an AAI of 0.87 (0.74-1.01). During the study 19 patients required amputation. Seven patients had an occluded graft, but had avoided amputation. Although the prognosis in regard to graft patency is poor, we still suggest that distal vascular surgery should be considered prior to primary amputation.