Experience with popliteal-infrapopliteal bypass grafting.

Ten patients with severe infrapopliteal arterial occlusive disease at the time of our evaluation underwent 11 vein bypasses confined to the below-knee segment. Previous reconstruction of the femoral and proximal popliteal arteries had been done in three limbs and were all patent at the time we performed the distal bypass. Eight limbs had minimal or no occlusive disease in the femoral and popliteal arteries and had no previous proximal arterial reconstruction. Tissue loss or rest pain was the indication for operation in all patients. There were no deaths. Two grafts occluded within 24 hours. Seven have remained patent from two to 48 months. Arteriography, including complete evaluation of the pedal vasculature, is needed to select these patients properly. Vein bypass grafts limited to the below-knee segment may be a useful alternative in selected patients to the more traditional femoroinfrapopliteal bypass grafts.