Secondary vascular procedures with @entity736 grafts for XXXX in a male veteran population.

@entity1 @entity736 @entity63
Secondary vascular procedures to below-knee vessels for @entity63 present a challenge to the vascular surgeon. Autogenous vein is often unavailable and failure of the previous bypass often limits the choice of distal vessels suitable for revascularization. This dilemma raises the question of amputation vs secondary vascular surgery. To address this question we reviewed the results of our previous aggressive approach to revascularization in a select group of 25 @entity1 (26 limbs) who had secondary procedures with @entity736 grafts to tibial vessels or the infragenicular popliteal artery with single-vessel runoff. Nine of these 26 bypasses (35%) have remained patent for a mean of 17.2 months and no amputations have been done in this group. The other 17 bypasses (65%) have occluded from 1 day to 36 months postoperatively (mean 4.3 months); 15 of these limbs have required major amputation (58%). Ten were performed within the first 3 months postoperatively. Thirteen of the 25 @entity1 died in the follow-up period (mean 27.5 months); five of these @entity1 had viable limbs. Of 12 surviving @entity1 (mean follow-up 19.9 months), six had viable limbs and six have required amputation. These results indicate that @entity1 having secondary vascular surgical procedures with @entity736 grafts to tibial vessels have a high amputation rate and poor overall survival. Within this select group of @entity1 , those who could walk with the aid of a prosthesis should be considered as candidates for primary amputation. This would facilitate rehabilitation and avoid the anguish of recurrent graft failure and multiple procedures.
