Occlusion of femoropopliteal bypasses (Biografts)

In a series of 225 femoropopliteal bypasses with a Biograft (1978-1983) there were 57 failures due to occlusion of the graft. The main cause was progressive atherosclerotic disease. Inflow obstruction occurred 12 times and outflow obstruction 27 times. Biograft-related causes were kinking of the graft in 7 and distal anastomotic stenosis in 11 cases. Forty nine of the 57 failures were submitted to reoperation. Inflow obstructions were corrected easily. Outflow obstructions were corrected with a jump graft in most of the above-knee cases. Outflow obstructions in the below-knee cases were difficult to correct. Thrombectomy and endarterectomy were successful on a few occasions. After occlusion of the Biograft due to kinking, a simple thrombectomy was always sufficient. Stenosis of the distal anastomosis made a patch angioplasty necessary. The 49 reoperations were initially successful in 38 patients (77%). Major amputation of the leg after an unsuccessful reintervention was necessary in 5 cases.