Twenty-three patients with threatened loss of a lower extremity due to advanced arteriosclerotic occlusive disease had poor runoff (none of the tibial vessels extending to the ankle). Although many would consider this an unfavorable prognosis for reconstruction, femoropopliteal bypass was performed using autogenous saphenous vein graft with preservation of functional extremities in 21 out of 22 surviving patients. Subsequent closure of the graft in three limbs at 11, 12, and 18 months did not reproduce the symptoms or threaten the viability of the extremities. This experience supports the suitability of severely ischemic extremities for revascularization despite poor runoff.
Purdy RT, Bole P, Makanju W, Munda R. Salvage of the Ischemic Lower Extremity in Patients With Poor Runoff. Arch Surg. 1974;109(6):784-786. doi:10.1001/archsurg.1974.01360060054014