Distal vein graft reconstruction for isolated tibioperoneal vessel occlusive disease in diabetics with critical foot ischaemia--does it work?

Since 1986, 75 distal vein bypass procedures have been performed in 72 diabetics with isolated tibioperoneal vessel occlusive disease for limb salvage. Fifty-six grafts were anastomosed proximally to the below-knee popliteal artery and 19 to the anterior tibial artery. Autologous vein was used in all patients. One patient died within the first postoperative month. Of the occluded grafts, only two which failed during hospitalisation were salvaged. In six patients progressive plantar gangrene necessitated below-knee amputation in spite of graft patency. Using life-table analysis, primary and secondary patency rates were 84 and 86% at 1 year and 71 and 76% at 5 years. One- and five-year limb salvage rates were 81 and 72%, respectively. Distal vein graft reconstruction for limb threatening ischaemia produces excellent patency rates and contributes significantly to limb salvage in these patients.