Femoropopliteal bypass revisited: an analysis of 138 cases

Femoropopliteal bypass is utilized for infrainguinal arterial reconstruction in patients with claudication, rest pain, non-healing ulcers and gangrene. Reported patency and limb salvage rates have varied considerably and controversy exists concerning conduit choice. The purpose of this study was to review the authors' results with femoropopliteal bypass to determine factors which may influence outcome in a contemporary series of patients. Between 1986 and 1991, 138 femoropopliteal bypasses were performed in 120 patients. Mean follow-up was 28 (range 1-66) months. Autogenous vein was used in 59% and polytetrafluoroethylene (PTFE) in the remainder. Above-knee anastomoses were performed in 34% and below-knee in 66%. The secondary patency for autogenous vein grafts (95% at 4 years) was significantly better than for PTFE grafts (69% at 4 years; P<0.01). Secondary patency for below-knee autogenous vein grafts also was better than that for below-knee PTFE grafts (95% versus 50% at 4 years; P<0.02). Limb salavage rates were worse for below-knee PTFE grafts than all other groups (P<0.01). Eight of 15 failed above-knee PTFE grafts were salvaged with below-knee autogenous vein grafts and did well. In the present series, autogenous vein femoropopliteal grafts demonstrated better overall patency and limb salvage. Below-knee PTFE bypasses should be reserved for limb salvage cases in patients without adequate autogenous conduits. Failed PTFE grafts can be salvaged by autogenous bypasses, yet an advantage to this approach was not seen.