Comparison of Above-Knee and Below-Knee Anastomosis in Femoropopliteal Bypass Grafts

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Abstract
• Experience with 555 femoropopliteal reconstructions was reviewed to evaluate the optimal location of the distal anastomosis. Autogenous vein was employed in 347 (63%) grafts and various prosthetics in 208 (37%). Vein grafts demonstrated marked superiority in late patency (73% at five years) vs prosthetic grafts (35% at five years). Below-knee (BK) anastomosis resulted in slightly better long-term patency in the vein graft group. In contrast, above-knee (AK) anastomosis was clearly preferable when prosthetic grafts were employed, particularly in patients with poor runoff or limb-threatening ischemia. The incidence of major amputation was greater following failure of BK grafts, reflecting the fact that a greater proportion of such grafts were done for limb salvage. However, failure of BK grafts did not appear to alter the level of amputation as compared with failed AK grafts. (Arch Surg 1981;116:1013-1018)