Objective:To compare the outcome of composite sequential bypass and reversed autologous saphenous vein bypass for severe chronic lower limb ischemia.
:Methods :From 2003 to 2005, 41 patients presenting with critical limb ischemia were divided into 2 groups: In 25 cases composite sequential bypass was carried out,While in 16 cases reversed autologous saphenous vein bypass was done. The composite sequential bypass was done with PTFE anastomosed proximally to the common femoral artery and distally to the isolated popliteal artery, and autologous saphenous vein extended from the distal PTFE and anastomosed to tibial or peroneal artery. The results were analysed by life table methods to discover the difference of primary patency, secondary patency and limb salvage between the 2 groups.
:Results:There were 18 patients with gangrene and 23 patients with rest pain.The mean age of patients was 67 years (range, 48-86 years). The cohort consisted of 29 male and 12 female patients.The mean follow-up was 18.7 months. In the composite graft group the outflow involved the peroneal artery in 6, the posterior tibial artery in 14, and the anterior tibial artery in 5.Primary graft patency at 1 y, 2 y and 3 y by lifetable analysis was 78%, 72% and 61%, respectively.Secondary graft patency of each year was 83%, 76% and 66%, respectively. Limb salvage rate was 83%, 73% and 73%, respectively. In the reversed saphenous vein group the outflow involved the peroneal artery in 3, the posterior tibial artery in 10, and the anterior tibial artery in 3. Primary graft patency at 1 y, 2 y and 3 y by lifetable analysis was 83%, 73% and 73%, respectively.Secondary graft patency of each year was 86%, 73% and 73%, respectively.Limb salvage rate was 93%, 79% and 79%, respectively.By the logrank test, there was not significent difference between the 2 groups.
:Conclusions:Composite sequential reconstruction using an isolated popliteal segment as supporting point for the distal reconstruction is an acceptable option in patients presenting with serious limb ischemia without enough venous conduit for distal bypass.