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Realistic Expectation for Patients Having Lower Extremity Bypass Surgery for Limb Salvage

Joseph A. O'Donnell, MD; Bruce J. Brener, MD; Donald K. Brief, MD; Joseph Alpert, MD; Victor Parsonnet, MD
Arch Surg. 1977;112(11):1356-1363. doi:10.1001/archsurg.1977.01370110090009.
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• Seventy-nine lower extremities bypass grafts were performed for salvage from 1972 through 1974. There were 64 femoral-popliteal (48 vein, nine composite, seven Dacron) and 15 femoral-tibial grafts. Data regarding sex, age, presence of diabetes, and arteriographic runoff were entered into a computer. Influence of these factors on patency, limb salvage, and patient survival were analyzed by the life table method. When the saphenous vein was present and a femoral-popliteal graft was performed, patency was acceptable (67% at five years), salvage was excellent, and operative mortality was low (6%). However, patency was reduced in the absence of a saphenous vein or if it was necessary to extend the graft to the tibial vessels. In fact, at five years, half the grafts were lost, almost half the limbs were amputated, and half the patients had died. An adverse effect was noted if the patient was a woman, diabetic, and/or had poor runoff. A realistic approach to these seriously ill patients takes these factors into account.

(Arch Surg 112:1356-1363, 1977)


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