Although the majority of patients presenting with symptomatic peripheral arterial
disease (PAD) are treated with the endovascular first approach, a significant number
of these patients still require open bypass because of the extent of atherosclerotic
burden or failure of the endovascular therapy. However, data available on the outcomes
of femoropoliteal bypass in the contemporary era of PAD management is scarce. In this
study, we evaluate realworld mid-term outcomes of femoropopliteal bypass for PAD.
We identified all patients who underwent open femoropopliteal revascularization with
autogenous vein conduits for PAD at one institution between January 2012 and December
2017. Main endpoints included primary patency, amputation-free survival, overall survival,
and limb salvage at 2 years. Outcomes were defined as per the Society for Vascular
Surgery standards. Descriptive statistics were performed using univariable analyses
including the mean and standard deviation for continuous variables and frequency and
percentage for categorical variables. Event-free survival rates were estimated using
There were 129 patients who received autogenous vein grafts. Median follow-up was
19 months (interquartile rangeIQR 11-26). Patients were predominantly male (59.7%),
white (72.9%) with a mean age of 65 ± 11 years. The indications for surgery were disabling
claudication in 36.4% of patients (n = 47) and chronic limb threatening ischemia (CLTI) in 63.6% (n = 82). Most patients had Trans-Atlantic Inter-Society Consensus C or D lesions (n = 81, 62.8%). Seventeen cases (16.3%) were redoing bypasses. Arm veins and spliced
vein conduits were used in 12% and 7%, respectively. In 66% of procedures, the distal
anastomosis was below the knee. Primary patency estimates at 6 months, 1 year and
2 years were 81.3%, 68.6% and 59.2%, respectively. Amputation-free survival rates
were 93.4%, 88% and 82.1% at 6 months, 1 year and 2 years, respectively. Limb salvage
rates among patients with CLTI were 93.4%, 90.4% and 87.2% at 6 months, 1 year and
2 years, respectively. Overall survival was 97.5%, 92.1% and 87.8% at 6 months, 1 year
and 2 years, respectively.
In this contemporary cohort of patients, femoropopliteal bypass showed lower patency
than previously described. The fact that bypass surgery is performed on sicker patients
with more extensive disease in the endovascular era might explain this discrepancy.
However, our results demonstrated satisfactory patency and limb salvage rates and
suggest that vein should always be used if available.