A Flexible Approach to Infrapopliteal Vein Grafts in Patients With Diabetes Mellitus

From October 1985 to August 1989, we performed 156 dorsalis pedis artery bypasses in 146 patients, 139 (95%) of whom had diabetes mellitus. A variety of surgical techniques were used to shorten surgery, limit incision length, and optimize size-matching between vein grafts and arteries whenever possible. Arterial inflow was from the common femoral artery in 58 cases, from the distal superficial femoral or popliteal artery in 88 cases, from a tibial artery in three cases, and from a preexisting bypass in seven cases. In situ (75 cases), ex situ reversed- or nonreversed-vein (62), composite vein (nine), and polytetrafluoroethylene (one) bypasses were constructed. Four patients (2.7%) died, and seven grafts (4.5%) failed within 30 days. Actuarial patency and limb salvage 6 to 52 months after surgery were 87.1% and 91.6%, respectively. There were no significant differences in patency between in situ and ex situ vein grafts (93.2% vs 89.7%) or between common femoral artery inflow site and distal superficial femoral/popliteal artery inflow site (89.3% vs 88%).