Comparison of above-knee and below-knee anastomosis in femoropopliteal bypass grafts.

Experience with 555 femoropopliteal reconstructions was reviewed to evaluate the optimal location of the distal anastomosis. Autogenous vein was employed in 347 (63%) grafts and various prosthetics in 208 (37%). Vein grafts demonstrated marked superiority in late patency (73% at five years) vs prosthetic grafts (35% at five years). Below-knee (BK) anastomosis resulted in slightly better long-term patency in the vein graft group. In contrast, above-knee (AK) anastomosis was clearly preferable when prosthetic grafts were employed, particularly in patients with poor runoff or limb-threatening ischemia. The incidence of major amputation was greater following failure of BK grafts, reflecting the fact that a greater proportion of such grafts were done for limb salvage. However, failure of BK grafts did not appear to alter the level of amputation as compared with failed AK grafts.