Long term results of autogenous vein bypass grafts in femoropopliteal arterial occlusion.

The results of 329 consecutive autogenous vein grafts carried out between January 1962 and June 1973 have been reviewed. The 5- and 10-year mortality rates were 14.6 per cent and 18.7 per cent respectively. The corresponding patency rates were 70 per cent at 5 years and 34 per cent at 10 years, the lowest patency (27.8 per cent) occurring in below-knee anastomoses with grafts of 5 mm or less in diameter. As other have noted, the state of the popliteal--tibial run-off vessels had a considerable influence on long term patency rates. In severely ischaemic limbs, the limb salvage rate following this operation was 77 per cent. An analysis of symptoms, associated disease and complications is presented and discussed. No valid conclusions could be made regarding the effect of lumbar sympathectomy and postoperative anticoagulants on long term patency. This review has confirmed the findings of earlier studies that a satisfactory 5-year patency rate and a gratifying limb salvage rate can be achieved with an extremely low operative mortality rate of 0.37 per cent. Despite the presence of widespread atherosclerotic arterial disease, the 5-year mortality rate is 14.6 per cent, indicating that an attempt at reconstructive surgery is usually well worth while.