Femoropopliteal and femorotibial arterial reconstructive surgery. Special reference to the autogenous venous bypass procedure using unreversed vein after eversion valvectomy.

The outcome of 127 femoropopliteal and 23 femorotibial arterial reconstructions carried out between January 1960 and December 1972 has been reviewed. The operative method was autogenous saphenous vein bypass in 109 cases, 82 of which were performed using unreversed vein with eversion valvectomy. The indication for reconstruction was advanced ischemia in 39%. Two patients died primarily and 23 late deaths have occurred subsequently. 19 grafts or reconstructed segments became occluded primarily. Most of them were femorotibial reconstructions of Dacron bypass reconstructions. Most of the failures occurred within 1 year of surgery. Using eversion valvectomy technique, the 1- and 5-year patency rates were 57 and 50% respectively. In femorotibial reconstructions the 1-year patency rate was 36%. There was a distinct difference in patency between the cases with excellent of good outflow and those with fiar or poor outflow. The difference was less distinct between patients with claudication and those with advanced ischemia. Eight limbs needed major amputation.