Comparative analysis of vein and prosthetic bypass grafts to the isolated popliteal artery

The effectiveness of prosthetic femoropopliteal bypass grafts to salvage limbs and maintain long-term patency in lower extremities with a limited outflow tract is controversial. To evaluate the results of prosthetic grafts and compare them with the results of vein bypass grafts in limbs with a limited outflow tract, we reviewed a 15-year experience with 65 grafts to an isolated popliteal artery segment. Fifty-one grafts were performed with autogenous saphenous vein, and 14 grafts utilized a prosthetic conduit. The indication for surgery was rest pain in 22 patients and actual tissue necrosis in 43 patients. The operative mortality rate was 3.4%. The average preoperative absolute ankle blood pressure was 48 mm Hg. Following a successful bypass, an average increase of 45 mm Hg was noted. The mean intraoperative blood flow was 70 ml/min. The superior performance of autogenous vein grafts was quite marked, with a 5-year cumulative patency of 65.4 +/- 8.5% as compared with only 17.1 +/- 10.1% for prosthetic grafts. The limb salvage rate for the entire group was 69% at 5 years. These data show the efficacy of isolated segment femoropopliteal artery grafts in achieving long-term limb salvage and stress the superiority of vein grafts over prosthetic grafts in this location.