INSITU BYPASS FOR LIMB SALVAGE - LONG-TERM RESULTS AND PATENCY FACTORS

One hundred limbs with critical ischemia (stages III and IV) were saved from 1983 to 1987 by in situ venous bypass at the lower femoropopliteal or femorotibial level. The average age of the patients was 66 (40-89) years. The surgical indication involved 51 cases of stage III ischemia and 49 of stage IV. The etiology of the ischemia was occlusive chronic arteritis (n = 67), diabetic arteritis (n = 20), embolic disease (n = 10) and aneurysmal disease (n = 3). The systolic pressure index in the ankle recovered an average value of 0,42 preoperatively. In 48 cases, the distal implantation of the graft was on the lower popliteal artery, and on the arteries of the leg in 52 cases. During the immediate postoperative period, 8 patients died and 13 underwent amputation. At 5 years, the limb salvage rate was 72 %. The primary patency at 5 years, calculated with the actuarial method, was 51 % and the secondary patency at 5 years was 62 %. Among the factors likely to significantly influence patency, only the site of the lower anastomosis and the quality of the III and IV segments of the popliteal artery were selected (p < 0.05), while the number of patent vessels in the leg and the clinical stage did not influence patency.