Distal anastomotic obstruction with patent infrainguinal bypass.

Hemodynamic graft failure due to distal anastomotic obstruction was observed in 13 patients following femoropopliteal-tibial graft. The majority of such grafts (10 out of 13) had been performed with reversed saphenous vein. Graft patency was confirmed by arteriography in all cases, with retrograde flow in the majority of cases. Jump graft to a more distal site was performed in nine patients. Two early major amputations (within 30 days) and two late major amputations (30 days to 1 year) resulted. Return of ischemic symptoms, diminution of graft or distal pulses, and decrease in ankle pressures is an indication for arteriography. Undetected hemodynamic graft failure leads to thrombosis of the graft necessitating far more complicated operative procedures.