Bypass grafts to the ankle and foot

Abstract

Two hundred forty-three bypasses to paramalleolar arteries were performed in 224 extremities of 208 patients since 1971; 166 were implanted in men (68%) and 77 in women (32%). The median age was 73 years. Gangrene (61%), nonhealing ulcer (15%), rest pain (22%), and trauma (2%) were the indications for bypass. Usual risk factors were noted: diabetes (65%), smoking (51%), heart disease (46%), and hypertension (45%). The extent of occlusive disease dictated three graft configurations: long grafts originating in arteries proximal to the adductor tendon (n = 111), short grafts originating at or below the popliteal artery (n = 88), and jump grafts originating near the distal end of a previous femorodistal bypass (n = 44). The association between diabetes (incidence 80%) and gangrene (75%) in patients with short grafts was statistically significant (p less than 0.01). The 2-year secondary patency rate of long in situ grafts was 92% compared with 72% for other autogenous vein long grafts. The limb salvage rate for all autogenous vein long grafts was 90% at 3 years. The secondary patency rate at 3 years for short grafts was 81% and the limb salvage rate was 80%. There were four amputations with patent grafts. Primary and secondary patency rates of jump grafts were similar (53%), whereas the limb salvage rate was 89% at 2 years. Patency and limb salvage rates of rarely employed nonautogenous conduits were less than 35% at 1 year (long grafts). Bypass grafts to the ankle and foot are effective and durable and should be performed with autogenous vein.

Vein bypasses to branches of pedal arteries

“…5,6,14,16 Although the present results for secondary patency are worse than those reported by Ascer et al 5 and Andros et al, 6 a 3-year limb salvage rate of 69% is considered satisfactory. In their study, there was a predominance of diabetes mellitus as the main associated disease.…”

“…2-4 These major arteries are sometimes occluded, but the branches (tarsal and plantar arteries) are patent and serve as runoffs for a bypass graft. 5,6 This an exceptional technique applicable to special conditions as a last attempt for limb salvage.Technical improvements in endovascular surgery have made this method feasible for many patients. It has been used as the initial approach to CLI treatment because of its low morbidity; however, the Bypass Versus Angioplasty in Severe Ischemia of the Leg (BASIL) trial reported better results for limb salvage and long-term survival in patients treated with bypass graft surgery, 7 and there are isolated reports of angioplasty performed on pedal arteries.…”

“…[2][3][4] These major arteries are sometimes occluded, but the branches (tarsal and plantar arteries) are patent and serve as runoffs for a bypass graft. 5,6 This an exceptional technique applicable to special conditions as a last attempt for limb salvage.…”

Angioscopy-Assisted In-Situ Saphenous Vein Bypass

“…(2) Small skin incisions have caused no problems with postoperative healing. (3) It is easy to locate competent or nondisrupted valves, perforators, and branches. (4) There is a decreased rate of AV fistulas after in-situ vein bypass graft.…”

Bypass Grafts: The State of the Art

“…More distal inflow sites provide durable inflow (13,14). Likewise, more proximal outflow is associated with durable patency when there is no significant obstruction between the distal anastomosis and the arterial segment leading to the foot.…”