The choice of material for above-knee femoropopliteal bypass. A 20-year experience.

OBJECTIVE

The choice of material for above-knee femoropopliteal bypass grafting is a matter of continuing controversy for various reasons. The most important argument in favor of alloplastic grafts is to preserve the autologous saphenous vein for a below-knee bypass, which might become indicated at a later date.

DESIGN

A consecutive series of above-knee reconstructions were analyzed with regard to long-term behavior. Early graft occlusions were not included, and the median follow-up was 83 months.

SETTING

A university hospital with a particular interest in vascular surgery.

PATIENTS AND

METHODS

Four hundred forty-two patients received either autologous saphenous vein (n = 310) or alloplastic graft (n = 132) material, and were analyzed in a univariate (Kaplan-Meier) and multivariate (Cox) manner.

MAIN OUTCOME MEASURES: Analysis as to whether alloplastic graft material provides equal or less favorable results as compared with autologous saphenous vein material, in terms of primary and secondary patency, secondary below-knee bypass grafting, limb salvage, and survival.

RESULTS

Although univariate analysis demonstrated a significantly better primary patency rate for autologous saphenous vein material, multivariate analysis did not show any effect of the material in terms of patency, limb salvage, and survival. The frequency of secondary below-knee repair was 7% (31 patients); 56% were performed in the first 2 years postoperatively. This amounted to an estimated probability of 4.4% and 12.3% at 18 years, respectively.

CONCLUSION

The small probability of secondary below-knee repair in our series does not support the policy to use alloplastic grafts routinely for a primary above-knee bypass, to spare the saphenous vein. Therefore, patients should be offered the best material for the first operation even at the above-knee level.