Outcome of infrainguinal arterial bypass grafting in limbs with postthrombotic syndrome

• From among 336 infrainguinal bypass proce dures performed for treatment of atherosclerotic occlu sive disease, 27 patients with histories of deep venous thrombosis (DVT) were retrospectively analyzed with re gard to patency and limb salvage rates. In 25 patients, venous diagnosis was verified by antegrade phlebogra phy, which demonstrated postthrombotic changes in the deep venous system. Indications for infrainguinal bypass surgery were severe claudication (six patients), rest pain (nine patients), and nonhealing ulcer or gangrene (12 pa tients). Sixteen autologous saphenous vein grafts, six composite (PTFE-vein), and five prosthetic grafts were used. All 11 femorodistal bypass grafts occluded within 6 months compared to an 82% patency rate of femo ropopliteal bypasses. Among 16 femoropopliteal by passes, only one patient with poor runoff underwent lower leg amputation after bypass failure. On the other hand, all 11 patients with distal bypass underwent major amputation during the first 7 months. The dismal outcome of patients with previous DVT undergoing femorodistal bypass procedures in this small population might be due to the deleterious effect of venous outflow impairment on already limited distal runoff status due to severe athero sclerotic changes.

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