Background: To assess the value of revascularization to crural and pedal arteries using the popliteal artery as inflow source.
Experimental design: Retrospective study with a mean follow-up period of 15.2 months (range, 0-46).
Setting: Academic referral center.
Patients: 62 patients with critical leg ischaemia and popliteal artery suitable as inflow source for infrapopliteal arterial revascularisation.
Interventions: 66 popliteal-to-distal bypass procedures, of which 18 popliteal-crural bypass grafts and 48 popliteal-pedal bypass grafts.
Main outcome measures: Bypass graft patency, leg salvage, survival and success defined as patients alive with leg.
Results: At 1-month, 1-year, and 2-year follow-up, the primary patency rates were 87%, 58%, and 55%, secondary patency rates were 95%, 70%, and 67%, leg salvage rates were 97%, 88%, and 88%, while 88%, 70%, and 66% of patients were alive with legs at the same intervals. At 2-year follow-up the survival rate was 72%. Above-knee popliteal-to-distal bypasses achieved better primary patency (p=0.02) and corrected primary patency rates (p=0.01) than below-knee popliteal-to-distal bypasses. Diabetes and uraemia affected the survival and patients alive with leg rates.
Conclusions: Popliteal-to-distal bypass surgery is worthwhile for the management of severe, isolated infrapopliteal atherosclerotic disease. Diabetic and uraemic patients are at high risk for both leg and life loss after revascularisation. Grafts originating from the above-knee popliteal artery may achieve better patency rates than those originating from the below-knee popliteal artery.