Comparison of Surgical Outcomes between Below-knee Femoro-popliteal and Femoro-infrapopliteal Bypasses after Using Autologous Reversed Saphenous Vein Graft

Nah, Mok Chan; Huh, Seung; Kim, Young Wook

Abstract

PURPOSE: Femoro-infrapopliteal bypass is usually indicated for the patients with critical leg ischemia and when below- knee femoro-popliteal bypass is not available. Considering the technical difficulties and requirement of longer vein graft, inferior surgical outcomes are anticipated after femoro-infrapopliteal bypass compared to below-knee femoro-popliteal bypass. We attempted to compare the early and late outcomes between the patients who underwent below-knee femoro-popliteal and femoro-infrapopliteal bypasses.
METHODS
Among 285 autologous reversed vein grafts implanted for the patients with chronic atherosclerotic leg arterial occlusion, the data base of 119 below-knee femoro-popliteal and 97 femoro-infrapopliteal bypasses (4 tibioperoneal trunk, 52 posterior tibial, 10 anterior tibial, 20 peroneal, and 11 inframalleolar arteries) were retrospectively reviewed to compare the patients characterisitics and surgical outcomes. To compare early postoperative outcome, operative mortality (<30 days), ankle-brachial pressure index, early graft failure, wound complication, and major limb amputation were compared and to compare late outcome, primary cumulative patency rates of vein grafts were compared between 2 groups. Cumulative patency rates were determined by Kaplan-Meier method and compared with log-rank test between 2 groups.
RESULTS
Demographic features and frequencies of comorbidities including diabetes, coronary artery disease, chronic obstructive lung disease and cerebrovascular disease were not different between 2 groups except renal insufficiency which is more frequent in femoro-infrapopliteal bypass group. And femoro-infrapopliteal bypasses were more commonly indicated for the patients with ischemic tissue loss and as repeated bypass and requiring spliced vein graft more commonly. There revealed no significant differences in the frequencies of operative mortality (<30 days), early graft failure, wound complication, and major limb amputation and the amount of ABI increase between 2 groups. Primary cumulative patency rates at 1, 3, and 5 years were 88.1 +/-3.5%, 77.3+/-5.1%, and 64.5+/-7.4% after B-K femoro- popliteal bypasses and 87.9+/-4.1%, 72.5+/-6.3%, and 60.4+/-10.1% after femoro-infrapopliteal bypasses, respectively revealing no significant differences between 2 groups.
CONCLUSION
In spite of anatomical and technical disadvantages associated with femoro-infrapopliteal bypasses, there revealed no significant difference in early and late outcomes between below-knee femoro-popliteal and femoro- infrapopliteal bypasses with autologous reversed vein graft.