Vein bypass to the tibial, peroneal and dorsalis pedis arteries for limb ischaemia.

Fifty-nine autogenous vein bypass grafts were performed to the distal leg arteries in 57 patients for limb salvage over a 10 year period.Analysis of results by the Life Table showed a cumulative patency of 74% at 1 month and 59% patency at 6 years. Failure of the vein graft in the early post-operative period resulted in amputation, and in almost 50% of cases, at an aboveknee level. Of 18 patients whose grafts thrombosed, 16 required major amputation, and infection in another 6 patients with patent grafts resulted in limb loss. With these exceptions, all the patients with patent grafts had viable and functional limbs. Of 37 diabetic patients subjected to operation, 17 lost their limbs during follow-up. There was no significant difference in patency of grafts inserted proximally or distally into the tibial vessels. The hospital mortality was 8% and one-fourth of patients subjected to operation died of causes related to atherosclerosis during follow-up.Reduction of the early post-operative failure rate by careful patient selection and meticulous operative technique makes arterial bypass operations to the distal tibial vessels beneficial to many patients who are otherwise doomed to amputation.