Factors determining outcome of reversed saphenous vein femoropopliteal bypass grafts.

The investigation was designed to study factors that might be of predictive value in femoropopliteal vein bypass grafting. A series of 146 grafts had a cumulative 5-year graft patency of 82.5 per cent. Five-year limb survival rate in salvage cases was 77.9 per cent. These results are encouraging. However, taking certain factors into account, the patency rates varied. In limbs with claudication, the 5-year graft patency rate was significantly higher than in salvage procedures (P < 0.05). Basal and maximal (during pharmacological vasodilatation) intraoperative graft flow rates were also significantly higher in claudicating limbs (P < 0.01). Reconstructions in limbs with a good run-off had better patency and flow rates than in limbs with a poor run-off (P < 0.001). This suggests that progression of distal atherosclerosis is a major factor for late graft thrombosis. The incidence of graft thrombosis was correlated with the flow rates (P < 0.01). Age, the presence of diabetes, graft diameter and the site of the distal anastomosis did not affect patency.