Isolated popliteal versus distal bypasses for limb salvage

The results of 54 bypass procedures--22 to an isolated popliteal segment and 32 to an infrapopliteal major calf vessel for limb salvage--were evaluated. After a distal bypass, the elevation of systolic pressure at the ankle was greater than that observed following a bypass to an isolated popliteal segment. However, healing times for ischemic lesions of the foot were comparable for each procedure. Patency and limb salvage rates for saphenous vein and polytetrafluoroethylene isolated popliteal segment bypasses were similar to those obtained with vein bypass grafts to infrapopliteal major calf vessels. In contrast, when polytetrafluoroethylene was used for a distal bypass below the popliteal artery, the failure rate was higher in the first year, with subsequent limb loss. These data suggest that, when a bypass operation is undertaken in the lower extremity for limb salvage, a bypass to an isolated popliteal segment, using either saphenous vein or polytetrafluoroethylene, is preferable to a polytetrafluoroethylene infrapopliteal bypass.