Preventing and Detecting Problems With Femoro-popliteal Grafts

Abstract

Femoropopliteal bypass with autogenous saphenous vein is effective in saving the limbs of patients threatened by ischaemia, with major amputation, even though we are dealing with elderly, and often unfit, patient population. In this personal series, one-third were diabetic, more than one-half had significant cardiac disease and all the non-diabetics were cigarette smokers. On life-table analysis (Fig. 1) it appears that at 5 Years approximately 60% will be alive with their own limbs. This is reassuring, but as with many statistical statements, it conveniently omits those patients with ischaemia who were denied the procedure in the first place. For example, in 100 consecutive cases referred to me, of severe limb ischaemia due to clinically diagnosed femoropopliteal disease, only 68 were submitted to arteriography and of these only 39 had femoropopliteal bypass grafting. In other words, case selection can distort results and compensate for surgical errors — if examined in terms of graft patency only.