Femoropopliteal saphenous vein bypass grafts

Our experience with 150 cases of femoropopliteal saphenous vein bypass grafting performed during the past nine years has been reviewed. A long-term patency rate of 84.6 per cent confirms our belief that the reversed autogenous vein bypass graft is the best operation in the treatment of occlusive disease of the femoropopliteal arteries. Our experience would seem to support the following conclusions: 1. 1. Long-term results do not appear to be significantly influenced by the clinical indications for surgery. 2. 2. It is impossible to determine the operability of any patient on clinical grounds alone. Patients with advanced gangrene may show an outflow tract ideally suited for grafting. 3. 3. There appears to be a poor correlation between the preoperative angiogram and the functional outflow tract found at surgery. 4. 4. Autogenous vein grafts appear to function well and remain patent for long periods of time despite limited outflow tracts such as an isolated popliteal segment or single vessel run-off. 5. 5. The long bypass graft from the common femoral artery to the distal popliteal artery below the knee is associated with the highest success rate. 6. 6. The success rate decreased significantly if the saphenous vein graft was less than 5 mm in diameter. 7. 7. The age of the patient alone does not appear to influence the success rate. 8. 8. Excellence in surgical technic is of utmost importance if a high degree of success is to be expected. Errors in technic probably account for most immediate failures and greatly influence the long-term results. 9. 9. Almost all patients facing immediate amputation because of gangrene should undergo femoral arteriography. When patients in this group were found suitable for venous bypass grafts, a success rate of 77.5 per cent was achieved with only a 5 per cent operative mortality.