Sequential bypass grafting for salvage of lower extremities

Since 1978, 12 patients at our institution have had distal sequential bypass grafting for limb salvage with either polytetrafluoroethylene (PTFE) or reversed saphenous vein and anastomoses to two different distal vessels. Seven patients had had previous vascular operations. One patient died of a stoke in the early postoperative period; a second patient, who was lost to follow-up several months after operation, was presumed to have died. Follow-up is otherwise complete (range seven to 48 months), without early or late limb loss. Results are encouraging and suggest that the sequential anastomotic technique may offer improved results in appropriate limb salvage cases with poor distal runoff.