Femoropopliteal graft failures. Clinical consequences and success of secondary reconstructions

We examined 188 failed femoropopliteal grafts during a 16-year period to evaluate the clinical consequences of graft failure and success of secondary revascularization procedures. In limbs with grafts placed for claudication, conditions of 9% with failed grafts remained improved despite graft occlusion, 67% returned to preoperative status, and 24% showed worsened ischemia. One third of claudicants with failed grafts underwent secondary procedures. Ultimately, only 7% of failed grafts in claudicants resulted in amputation, and overall risk of limb loss in patients undergoing operation for claudication alone was low (2%). After failure of grafts performed for limb-salvage indications, 21% of limbs were still improved, and 79% reverted to limb-threatened status, more than half of the limbs undergoing subsequent reoperation. Overall, secondary attempts at reconstruction appeared justified. Although the five-year patency rate of such grafts was only 31%, limb salvage was achieved in 52%, with relatively low morbidity and mortality.