Fate of claudicants after femoropopliteal vein bypass: prospective, long-term follow-up of 100 patients.

Femoropopliteal bypass grafting for claudication is a controversial procedure. One hundred consecutive patients so treated were analysed for vein-graft patency, subsequent operation and survival. Initial success, treatment of incipient graft failure and attrition from death were the three critical factors influencing long-term benefit. Cumulative graft patency, after revision when necessary, was 89%, 86% and 78% at 2, 5 and 10 years respectively. In assessing the real benefit of surgery in this group, it is important to consider the effect of late deaths, as the life expectancy of these patients is so often shortened by related disease; the "cumulative palliation" (patient alive and graft patent) was 82%, 67% and 28% at the same time intervals. The concept of cumulative palliation sets a high standard in assessing results of vascular surgery, adding important information to the usual graft patency rates that ignore the effect of death. These results suggest a place for femoropopliteal vein bypass grafting in selected claudicants.