Femoropopliteal bypass to the isolated popliteal segment: is polytetrafluoroethylene graft acceptable?

In a series of 148 polytetrafluoroethylene femoropopliteal bypasses performed for limb salvage, 33-month life-table cumulative patency rates for grafts inserted into an isolated popliteal artery segment (91% +/- 5%) were not significantly different from those inserted into a popliteal segment with angiographically better runoff (78% +/- 5%). Similarly, below-knee reconstructions had 3-year patency rates (86% +/- 6%) that were not significantly different from those for bypasses inserted into the popliteal artery above the knee (79% +/- 6%). One clear disadvantage of the isolated popliteal artery segment as a site for distal insertion of the bypass was the increased incidence of limb loss despite a patent reconstruction. This was particularly frequent in diabetics with extensive foot gangrene or infection and could be avoided by a secondary extension of the bypass to a patent distal leg or foot artery.