[20 years orthograde venous bypass for infrainguinal arterial reconstruction]

During a 20-year period (1973-1993) a series of 684 orthograde vein bypass procedures with the translocated greater (or lesser) saphenous vein was performed in 629 patients (422 male, 207 female) of whom 221 (35%) were diabetics. There were 499 femoro-popliteal grafts to the infrageniculate popliteal artery, 158 femoro-crural and 27 popliteo-crural grafts. Indication for surgery was rest pain and/or tissue necrosis in 404, claudication in 277 and asymptomatic popliteal artery aneurysm in 3 extremities. All patients received long-term oral anticoagulation and were followed at regular intervals. At the concluding follow-up (01-06/1993) graft function was investigated by colour flow duplex scanning and/or arteriography. Cumulative patient survival at 1, 5, 10 and 15 years was 90.6%, 62.8%, 38.6% and 27.1%. Multivariate analysis (Cox-model) proved that preoperative clinical status (rest pain and tissue necrosis vs. claudication and asymptomatic popliteal artery aneurysm) (p < 0.0001) and diabetes (p < 0.001) were significant factors for survival. The 30-day patency rate was 93%, and the secondary cumulative patency rates (life-table method) were 85.7%, 78.6%, 73.8% and 65.9% at 1, 5, 10 and 15 years. Only the preoperative clinical status was a weak prognostic factor (Mantel p < 0.029) whereas diabetes or the level of proximal and distal anastomosis were without importance for graft performance. Cumulative limb salvage rates (life-table method) at 1, 5, 10 and 15 years were 91.2%, 85.6%, 83.4% and 79.9% for the 404 legs operated for rest pain and or necrosis; and they were 100%, 98.8%, 97.7% and 94.9% for the 277 legs with claudication.(ABSTRACT TRUNCATED AT 250 WORDS)