The utility and durability of vein bypass grafts originating from the popliteal artery for limb salvage

Joseph L Mills, Vivian Gahtan, Roy M. Fujitani, Spence M. Taylor, Dennis F. Bandyk

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

background:Shorg vein grafts originating from sites distal to the common femoral artery have been reported to be useful in selected patients with tibial artery disease. From 1987 to 1993, we performed 504 consecutive infrainguinal vein bypass grafts, of which 56 (11%) originated from the popliteal artery, 25 above and 31 below the knee. patients and methods: The patients were 16 women and 37 men, with a mean age of 62.4 years. Eighty-seven percent were diabetic, 57% had clinically obvious coronary artery disease, and 28% had end-stage renal disease (ESRD). The indication for surgery was ulceration or gangrene in 93% of cases. We preferentially used reversed greater saphenous vein harvested from the thigh to optimize conduit quality and avoid lower leg wound complications. The outflow artery sites were: dorsal pedal (17), posterior tibial (14), peroneal (10), anterior tibial (8), lateral or medial plantar (5), and sequential tibial (2). All patients were followed postoperatively with serial duplex surveillance. The mean follow-up was 12.5 months (range 1 to 66). results: In-hospital mortality was 5.4%. Mortality at 24 months was 19% overall and 38% in patients with ESRD. Limb salvage was 77% at 3 years, 92% in patients with normal renal function versus 59% in those with ESRD (P <0.003). Primary graft patency by life-table analysis was 94% at 1 month and 84% at 3 years. Five patients with patent grafts required amputation, 4 early and 1 late. Eight months after surgery, 1 patient (1.8%) developed superficial femoral artery stenosis which was diagnosed by duplex surveillance and successfully treated by percutaneous transluminal balloon angioplasty. conclusions: Vein bypass grafts originating from the popliteal artery are effective and durable. Proximal disease progression rarely poses a significant threat to long-term graft patency. Patients with ESRD, blind tibial outflow tracts, and extensive forefoot lesions appear to be at increased risk of limb loss even with continued graft patency.

Original languageEnglish (US)
Pages (from-to)646-651
Number of pages6
JournalAmerican Journal of Surgery
Volume168
Issue number6
DOIs
StatePublished - 1994
Externally publishedYes

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Popliteal Artery
Limb Salvage
Veins
Transplants
Chronic Kidney Failure
Femoral Artery
Tibial Arteries
Life Tables
Gangrene
Balloon Angioplasty
Saphenous Vein
Hospital Mortality
Thigh
Amputation
Angioplasty
Disease Progression
Foot
Coronary Artery Disease
Leg
Knee

ASJC Scopus subject areas

  • Surgery

Cite this

The utility and durability of vein bypass grafts originating from the popliteal artery for limb salvage. / Mills, Joseph L; Gahtan, Vivian; Fujitani, Roy M.; Taylor, Spence M.; Bandyk, Dennis F.

In: American Journal of Surgery, Vol. 168, No. 6, 1994, p. 646-651.

Research output: Contribution to journalArticle

Mills, Joseph L ; Gahtan, Vivian ; Fujitani, Roy M. ; Taylor, Spence M. ; Bandyk, Dennis F. / The utility and durability of vein bypass grafts originating from the popliteal artery for limb salvage. In: American Journal of Surgery. 1994 ; Vol. 168, No. 6. pp. 646-651.
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title = "The utility and durability of vein bypass grafts originating from the popliteal artery for limb salvage",
abstract = "background:Shorg vein grafts originating from sites distal to the common femoral artery have been reported to be useful in selected patients with tibial artery disease. From 1987 to 1993, we performed 504 consecutive infrainguinal vein bypass grafts, of which 56 (11{\%}) originated from the popliteal artery, 25 above and 31 below the knee. patients and methods: The patients were 16 women and 37 men, with a mean age of 62.4 years. Eighty-seven percent were diabetic, 57{\%} had clinically obvious coronary artery disease, and 28{\%} had end-stage renal disease (ESRD). The indication for surgery was ulceration or gangrene in 93{\%} of cases. We preferentially used reversed greater saphenous vein harvested from the thigh to optimize conduit quality and avoid lower leg wound complications. The outflow artery sites were: dorsal pedal (17), posterior tibial (14), peroneal (10), anterior tibial (8), lateral or medial plantar (5), and sequential tibial (2). All patients were followed postoperatively with serial duplex surveillance. The mean follow-up was 12.5 months (range 1 to 66). results: In-hospital mortality was 5.4{\%}. Mortality at 24 months was 19{\%} overall and 38{\%} in patients with ESRD. Limb salvage was 77{\%} at 3 years, 92{\%} in patients with normal renal function versus 59{\%} in those with ESRD (P <0.003). Primary graft patency by life-table analysis was 94{\%} at 1 month and 84{\%} at 3 years. Five patients with patent grafts required amputation, 4 early and 1 late. Eight months after surgery, 1 patient (1.8{\%}) developed superficial femoral artery stenosis which was diagnosed by duplex surveillance and successfully treated by percutaneous transluminal balloon angioplasty. conclusions: Vein bypass grafts originating from the popliteal artery are effective and durable. Proximal disease progression rarely poses a significant threat to long-term graft patency. Patients with ESRD, blind tibial outflow tracts, and extensive forefoot lesions appear to be at increased risk of limb loss even with continued graft patency.",
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AU - Bandyk, Dennis F.

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N2 - background:Shorg vein grafts originating from sites distal to the common femoral artery have been reported to be useful in selected patients with tibial artery disease. From 1987 to 1993, we performed 504 consecutive infrainguinal vein bypass grafts, of which 56 (11%) originated from the popliteal artery, 25 above and 31 below the knee. patients and methods: The patients were 16 women and 37 men, with a mean age of 62.4 years. Eighty-seven percent were diabetic, 57% had clinically obvious coronary artery disease, and 28% had end-stage renal disease (ESRD). The indication for surgery was ulceration or gangrene in 93% of cases. We preferentially used reversed greater saphenous vein harvested from the thigh to optimize conduit quality and avoid lower leg wound complications. The outflow artery sites were: dorsal pedal (17), posterior tibial (14), peroneal (10), anterior tibial (8), lateral or medial plantar (5), and sequential tibial (2). All patients were followed postoperatively with serial duplex surveillance. The mean follow-up was 12.5 months (range 1 to 66). results: In-hospital mortality was 5.4%. Mortality at 24 months was 19% overall and 38% in patients with ESRD. Limb salvage was 77% at 3 years, 92% in patients with normal renal function versus 59% in those with ESRD (P <0.003). Primary graft patency by life-table analysis was 94% at 1 month and 84% at 3 years. Five patients with patent grafts required amputation, 4 early and 1 late. Eight months after surgery, 1 patient (1.8%) developed superficial femoral artery stenosis which was diagnosed by duplex surveillance and successfully treated by percutaneous transluminal balloon angioplasty. conclusions: Vein bypass grafts originating from the popliteal artery are effective and durable. Proximal disease progression rarely poses a significant threat to long-term graft patency. Patients with ESRD, blind tibial outflow tracts, and extensive forefoot lesions appear to be at increased risk of limb loss even with continued graft patency.

AB - background:Shorg vein grafts originating from sites distal to the common femoral artery have been reported to be useful in selected patients with tibial artery disease. From 1987 to 1993, we performed 504 consecutive infrainguinal vein bypass grafts, of which 56 (11%) originated from the popliteal artery, 25 above and 31 below the knee. patients and methods: The patients were 16 women and 37 men, with a mean age of 62.4 years. Eighty-seven percent were diabetic, 57% had clinically obvious coronary artery disease, and 28% had end-stage renal disease (ESRD). The indication for surgery was ulceration or gangrene in 93% of cases. We preferentially used reversed greater saphenous vein harvested from the thigh to optimize conduit quality and avoid lower leg wound complications. The outflow artery sites were: dorsal pedal (17), posterior tibial (14), peroneal (10), anterior tibial (8), lateral or medial plantar (5), and sequential tibial (2). All patients were followed postoperatively with serial duplex surveillance. The mean follow-up was 12.5 months (range 1 to 66). results: In-hospital mortality was 5.4%. Mortality at 24 months was 19% overall and 38% in patients with ESRD. Limb salvage was 77% at 3 years, 92% in patients with normal renal function versus 59% in those with ESRD (P <0.003). Primary graft patency by life-table analysis was 94% at 1 month and 84% at 3 years. Five patients with patent grafts required amputation, 4 early and 1 late. Eight months after surgery, 1 patient (1.8%) developed superficial femoral artery stenosis which was diagnosed by duplex surveillance and successfully treated by percutaneous transluminal balloon angioplasty. conclusions: Vein bypass grafts originating from the popliteal artery are effective and durable. Proximal disease progression rarely poses a significant threat to long-term graft patency. Patients with ESRD, blind tibial outflow tracts, and extensive forefoot lesions appear to be at increased risk of limb loss even with continued graft patency.

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