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November 1973

Reconstructive Surgery Distal to the Popliteal TrifurcationEffect on the History of Arterial Occlusive Disease

Author Affiliations

From the Department of Surgery and the Harrison Department of Surgical Research, University of Pennsylvania, Philadelphia. Dr. Nicholas is now with the Milton S. Hershey Medical Center, Hershey, Pa.

Arch Surg. 1973;107(5):652-656. doi:10.1001/archsurg.1973.01350230012004

To assess the benefits of femorotibial or femoroperoneal bypass grafts in severely ischemic limbs, the results of 44 such procedures were compared with results in 41 legs which were not operated upon. The control group, with a similar degree of ischemia, studied retrospectively, had femoropopliteal occlusive disease with angiographic evidence of reconstitution of at least one major branch of the popliteal artery, thus satisfying our present criteria for bypass surgery. Of 44 grafts observed for 30 days to 8 years, 15 have failed, 11 of these in the first month. After one year, 79.6% of patients having bypasses had avoided amputation as compared with only 34.1% in control group. Thus, it does not seem that the fear either of late graft occlusion or of progression of arteriosclerosis justifies refusal of operative reconstruction to these patients.