Long-term prognosis of femoropopliteal bypass: an analysis of 349 consecutive revascularizations.

BACKGROUND

Femoropopliteal bypass is the commonest procedure for lower limb revascularization. The aim of the present study was to determine the long-term outcomes of femoropopliteal bypass and evaluate the prognostic significance of various clinical factors on the long-term results.

METHODS

From 1976 to 1998, 349 consecutive primary femoropopliteal bypass operations were performed on 314 patients at the University of Hong Kong Medical Centre. Indications for operation included claudication (n = 85) and limb-threatening ischaemia (n = 264). Univariate and multivariate analyses of 14 clinical variables were undertaken to identify significant prognostic factors affecting the graft patency, limb salvage and patient survival rates.

RESULTS

The overall primary patency rates of femoropopliteal bypass were 88%, 79% and 76% at 1, 3 and 5 years, respectively. Type of graft material and age of patient were independent prognostic factors of graft patency. The cumulative limb salvage rates were 90%, 86% and 86% at 1, 3 and 5 years, respectively. No clinical factor was found to be predictive of ultimate limb loss. The overall survival rates were 89%, 85% and 78% at 1, 3 and 5 years, respectively. Coronary artery disease was the main cause of late death. Gender and indication for operation were the significant predictive factors of long-term survival.

CONCLUSIONS

Femoropopliteal bypass using reversed long saphenous vein provided the most durable long-term patency. Autologous saphenous vein should be the choice of vascular conduit if available. Male gender and limb-threatening ischaemia were associated with a poor survival.