Small vessel leg angiography for distal vessel bypass grafts

Abstract

To improve visualization of the small vessels for distal bypass grafting, arteriograms of the lower extremity were obtained in 187 patients by use of active warming of the extremities, selective distal positioning of the catheter for contrast agent injections, and intraarterial administration of tolazoline. With these techniques, satisfactory visualization was obtained for planning of operation, and in only one patient was an intraoperative arteriogram necessary before bypass grafts were placed.

Functional foot salvage after extensive plantar excision and amputations proximal to the standard transmetatarsal level

“…We share the view of others that in patients with multisegmental occlusive dis- ease, there is a high resistance to the flow of blood and angiographic dye and this often results in incomplete demonstration of the outflow) 2' 17"19 Some surgeons have chosen to use digital subtraction angiography or other means to supplement the preoperative anglogram. 17,19 We prefer to use intraoperative prereconstruction angiography (IPA) through a tibial or pedal artery. In our experience IPA provides accurate information to determine reconstructability (on the basis of the status of the pedal arch) and the optimal placement of the distal anastomosis.…”

Pedale Bypasschirurgie bei diabetischen Fußsyndrom: Indikation, Technik und Ergebnisse

“…Sollte bereits zuvor eine duplexsonographische Untersuchung der Beckenarterien eine signifikante Stenosierung ausgeschlossen haben, kann auch eine alleinige Darstellung der peripheren Gefäße unterhalb des Leistenbandes durch eine Feinnadel-DSA ausreichen. Im Einzelfall wird eine aussagekräftige Beurteilung der Fußgefäße erst durch eine selektive Katheterangiographie möglich [33]. Da jedoch bei vielen Patienten mit diabetischem Spätsyndrom bereits eine Einschränkung der Nierenfunktion vorliegt, besteht aufgrund der Nephrotoxizität des Kontrastmittels grundsätzlich die Gefahr einer weiteren Nierenschä-digung [49].…”

Round Table Discussion: "Redo" Leg Revascularization

“…A bypass had been performed in the left leg several years before, which was functioning properly. A femoral below-knee saphenous vein bypass was performed in the right leg at the regional hospital 1 week after his admittance and the right foot rest pain recurred. A week later the newly constructed right femoral popliteal graft thrombosed.…”