Uhl C et al. – This study assessed the outcomes of prosthetic or autologous vein for femoropopliteal (P3) bypasses performed in critical limb ischemia (CLI) patients in whom endovascular therapy is not considered feasible or has failed. The authors demonstrated that bypasses to the below–knee popliteal artery show good results. Vein remains the first–line graft material.

Methods

• The authors retrospectively assessed patients undergoing femoropopliteal (P3) bypass for CLI where endovascular therapy was not possible.
• Parameters analyzed were patency rates, limb salvage, major adverse limb event (MALE)–free survival, and survival after 5 years.

Results

• Analyses included 151 cases (rest pain 35.8%, ulcer/gangrene 64.3%).
• Autologous vein was the graft material for 76 cases (vein group), whereas heparin–bonded expanded polytetrafluoroethylene was in 75 cases (HePTFE group).
• Indications, risk factors, previous revascularization procedures, and runoff vessels were similar in both groups.
• 30–day mortality was 6.6% in the vein group compared with 5.3% in the HePTFE group.
• The vein and HePTFE groups had similar early graft occlusion (6.6% vs 5.3%) and a 30–day major amputation rate (0% vs 2.7%).
• Overall primary and secondary patency was 51.7% and 64.2%, respectively, all without significance after 5 years.
• Limb salvage (79.1%) was significantly different between the 2 groups (90.0% vs 62.9%).
• Survival and MALE–free survival were similar between the 2 groups.