Of 85 consecutive cases of saphenous vein bypass graft with infrageniculate distal anastomosis, ischemic rest pain or gangrene was present in 73 (86%). In the remainder, disabling claudication was the indication for surgery. Patients with rest pain or gangrene had a high incidence of diabetes mellitus and associated cardiovascular disease. Hospital mortality was 8% in patients operated upon for rest pain or gangrene. Four early graft occlusions resulted in three major amputations. Other complications were uncommon. Personal follow-up revealed long-term graft patency and limb salvage in 81% of patients operated upon for rest pain or gangrene. Diffuse tibial occlusive disease was responsible for late graft occlusion or amputation. This report supports the superiority of infrageniculate vein bypass over other methods of femoral-popliteal reconstruction, for patients who otherwise face immediate amputation.
Shore E, Foran R, Golding A, Treiman R. Femoral-Popliteal Occlusive DiseaseSaphenous Vein Bypass Grafts Below the Knee: Analysis of 85 Consecutive Cases. Arch Surg. 1971;102(6):548-551. doi:10.1001/archsurg.1971.01350060012005