Improved patency in reversed femoral-infrapopliteal autogenous vein grafts by early detection and treatment of the failing graft.

One hundred two femoral-infrapopliteal bypasses, in which reversed autogenous saphenous vein grafts were used, were performed from January 1978 to July 1984, in 94 patients with severe claudication (14%) or threatened limb loss (86%). Follow-up examinations at 3-month intervals during the first 18 months and at 6-month intervals thereafter were performed to document the return of ischemic symptoms or loss of peripheral pulses. Ankle pressure index and pulse volume recordings were also measured. A decrease in ankle pressure index equal to or greater than 0.2 or a pulse volume recording decrease of 5 mm or more with or without confirmatory symptoms were indications for repeat arteriography. Twenty-two primary graft or anastomotic stenoses were discovered in 19 grafts during follow-up. Seventy-eight percent of these lesions were treated primarily by percutaneous transluminal angioplasty and the remainder were treated by short proximal interposition grafts or patch graft angioplasty. Twenty-five grafts occluded during follow-up and all of these were considered to have failed for purpose of life-table analysis. Stenotic lesions, which were corrected before occlusion, were listed as continuously patent under secondary patency and as failed under primary patency life-table analysis. The secondary graft patency rate was 70% at 5 years, which was significantly higher (p less than 0.01) than the primary patency rate (47%), which was obtained without intervention. This 23% differential represents graft salvage achieved by careful surveillance and is reflected not only by improved patency but also by high limb salvage rates (86%) observed at 5 years.