Femorotibial bypass grafts with sequential technique. Clinical results.

Twenty-three patients (mean age, 71 years) have undergone femorotibial bypass grafting with a sequential side-to-side popliteal anastomosis since 1975, 96% because of threatened limb loss. Twenty-one grafts were of autogenous saphenous vein and two were composites of prosthesis and vein. Ankle-brachial indices increased from 0.40 +/- 0.27 to 0.84 +/- 0.36. Intraoperative flow measurements showed a 40% to 75% augmentation in flow with the sequential anastomosis. Patients who required amputation in the early postoperative period because of graft failure failed to show improvement in ankle indices and did not manifest healing of their ischemic ulcerations. Nineteen of 23 limbs (83%) were salvaged by operation. Follow-up ranged from two to 50 months (mean, 23 months). Graft patency calculated by the life-table method was 74% at one year, 68% at two years, and 62% at four years.