Femoropopliteal Saphenous Vein Bypass for Occlusive Atherosclerosis Causing Leg Ischaemia

Abstract

During a seven-year period, 100 femoropopliteal reversed saphenous vein graft bypass operations were performed for occlusive atherosclerosis causing intermittent claudication (63 cases) and rest pain or gangrene (37 cases). Polysymptomatic atherosclerosis, cigarette consumption, diabetes and hyperlipemia were far more prevalent than in non-ischaemic persons. All patients were followed up for 3 months, 91 for 1 year, 59 for 3 years and 34 for 5 years. Hospital mortality was 4%. Mortality after 1, 3 and 5 years was 7%, 30% and 50%. Mortality was higher in patients operated on for rest pain/gangrene, in septuagenarians, in diabetics, and in patients having polysymptomatic atherosclerosis. Nearly all deaths were caused by cardiac or cerebral ischaemic disease.

Hospital mortality was 4%. Mortality after 1, 3 and 5 years was 7%, 3006 and 50%. Mortality was higher in patients operated on for rest pain/gangrene, in septua- genarians, in diabetics, and in patients having polysympto- matic atherosclerosis. Nearly all deaths were caused by cardiac or cerebral ischaemic disease.

The hospital graft failure rate was 6%. After 1, 3 and 5 years 20%, 37% and 47% had failed. There were one early and one late amputation in the claudication group, and 3 early and 8 late amputations in the rest pain/gangrene group. the early limb salvage rate was 81 76, while 5546, 21% and 7% of patients operated on for rest pain/gangrene were living with a patent graft and a viable limb 1, 3 and 5 years after operation. Graft patency in patients leaving hospital alive was 94%. in patients living 1, 3 and 5 years later graft patency was 80%, 66% and 47%. Patency was lower in patients operated on for rest pain/gangrene, in diabetics, in patients having polysymptomatic atherosclerosis, and in patients having poor angiographic run-off. About 2/3 of patients disabled from work by their leg ischaemia were rehabilitated.

Based on our results, we believe indications for femoro-popliteal vascular surgery are extensive as an alternative to primary amputation in rest pain and gangrene. Patients having claudication should generally only be operated on if the symptoms cause prolonged disability to work, and provided the angiographic run-off is good or fair. the reversed saphenous vein graft bypass is a safe operation for routine use, yielding acceptable results in the hands also of general surgeons, as demonstrated in the present work.