A 65-year-old diabetic with critical limb ischemia (CLI) has an ABI of 0.35. Angiography shows a long segment SFA occlusion with patent popliteal and tibial vessels. Endovascular treatment is not feasible. The preferred bypass conduit for femoro-popliteal bypass is:
- A Autologous reversed great saphenous vein graft ✓
- B PTFE (polytetrafluoroethylene) graft
- C Cryopreserved cadaveric saphenous vein
- D Dacron (polyester) graft
Explanation
For infrainguinal bypass surgery (femoro-popliteal or femoro-tibial), autologous great saphenous vein (GSV) — either reversed or in situ — is the gold standard conduit with the best long-term patency rates. GSV resists infection, adapts to arterial flow dynamics, and has superior 5-year patency (approximately 60-70% for above-knee, 50-60% for below-knee) compared to prosthetic grafts. PTFE and Dacron are acceptable for above-knee femoro-popliteal bypass if GSV is unavailable (primary patency around 50% at 5 years), but have substantially inferior patency for below-knee anastomoses. Cryopreserved vein has significantly worse results and is a last resort. For a diabetic with CLI, using GSV if available is strongly preferred.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.