Results of Below Knee Bypass Operation for Limb Salvage in Thromboangiitis Obliterans

Abstract

The below knee bypass operation has become a widely accepted procedure for salvaging ischemic lower extremities with arteriosclerosis obliterans (ASO).1-4 However, surgical treatment of thromboangiitis obliterans (TAO) still raises unsettled questions about indications and operative techniques. Applications of reconstructive surgery are limited, and the reported results are not so favorable because of diffuse inflammatory occlusion in the peripheral arteries of limbs. Thus most ischemic limbs are treated by sympathectomy or amputation.Detailed results of the distal artery bypass in TAO are not yet available, but we have tried an aggressive application of the bypass operation for limb salvage in TAO. This report compares our experience with distal artery bypass in patients with TAO and in those with ASO. Materials and Methods... From January 1962 to December 1977, 155 cases of TAO and 133 cases of ASO were treated at the Second Department of Surgery of Hokkaido University Hospital. Sympathectomy, the most frequently applied procedure in TAO patients, was performed in 100 of 155 cases or 64.5%. Reconstructive surgery was possible in 42 cases of TAO or 27.1%. A distal artery (below knee) bypass operation was carried out on 25 limbs in 22 TAO patients.In patients with ASO, reconstruction was the major procedure. It was used in 81 of 133 cases or 60.9%, including below knee bypass operations on 37 limbs in 29 patients.