The influence of knee joint movements on infrainguinal bypass

Kinking of synthetic grafts during knee flexion is thought to be a significant cause of failure of below-the-knee bypasses. The real impact of knee joint motion on infrainguinal bypass in terms of patency rates and mechanisms of thrombosis is still under discussion, however, and is reviewed in this article. Review of the literature shows that studies investigating the behaviour of vascular grafts during knee flexion are rare, involve small series of patients and few long-term follow-up angiograms. For accurate postoperative assessment both frontal and lateral projection angiography are necessary and under these conditions, it appears that not only synthetic but also saphenous veins kink.