The role of composite sequential bypass in the treatment of multilevel infrainguinal arterial occlusive disease

Background In this study, the efficacy of composite sequential bypass is compared to that of standard in situ bypass, and to alternate prosthetic graft systems which have been used for the treatment of multilevel infrainguinal arterial occlusive disease in the absence of suitable autogenous vein. Patients and methods A retrospective review of graft patency and limb salvage included 197 patients undergoing 211 bypass procedures consisting sequential (CS; n=35), of in situ femoral-tibial (IS; n=119); compositeprosthetic femoropopliteal with single (PFP-1; n=30) or no vessel runoff (PFP-O; n=9), and prosthetic femoral-tibial (PFT; n=18) bypass. Results By life-table analysis, IS bypass provided superior primary (P< 0.005) and secondary (P< 0.0005) patency over the other groups. CS bypass was similar to PFP-1, with a 2-two year primary patency of 35% and 44% (NS), respectively, and limb salvage rates of 60% and 80% (P =0.01). PFP-O and PFT bypass procedures did considerably worse, with a 1-year patency of 19% and 22%, respectively, and associated limb salvage rates of 25% and 41% (NS). Conclusions Composite sequential bypass is an acceptable procedure for infrainguinal arterial reconstruction when absence of autogenous vein prevents either in situ or secondary vein graft bypass procedures.