The tourniquet revisited as an adjunct to lower limb revascularization

Ciervo, Alfonso; Dardik, Herbert; Qin, Feng; Silvestri, Fred; Wolodiger, Fred; Hastings, Barry; Lee, Sung; Pangilinan, Audwin; Wengerter, Kurt R.

doi:10.1016/s0741-5214(00)90302-1

Cited by 11 publications

(12 citation statements)

References 11 publications

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“…After application of the Esmarch bandage the anastomosis can easily be performed in a bloodless fi eld. This experience is confi rmed by previous reports from other authors who fi nd the use of a tourniquet very helpful in distal bypasses [26][27][28][29]. Our concept of surgical revascularization for TAO in selected cases is supported by a recent positive report from an Italian author describing a distal bypass in a case of extensive gangrene in a patient with TO [30].…”

Section: Discussionsupporting

confidence: 79%

Very distal vein bypass in patients with thromboangiitis obliterans

Neufang

Vargas-Gomez

Ewald

et al. 2017

Vasa

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Summary:Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex fi ndings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin confi guration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superfi cial femoral artery was used for infl ow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identifi ed graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after defi nitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.Keywords: Thromboangiitis obliterans, bypass, limb salvage, human, vascular patency ease frequently involves the small distal arteries of the calf and the foot with complete obliteration of the vessel lumen and absence of a suitable distal artery for bypass. The angiographic pattern of TAO is characterized by occlusions of the tibial and pedal arteries and the presence of typical corkscrew collaterals with normal proximal arteries [2,3]. Surgical revascularization with autologous vein bypass is rarely regarded as feasible due to the absence of healthy distal arterial segments or because of the small calibre of patent arteries and recent advances in conservative treatment. Superfi cial veins may become aff ected by the disease in form of phlebitis migrans with consecutive infl ammatory changes [4]. Hence previous infl ammation of the superfi cial veins often limits their availability as bypass grafts. However surgical vein bypass was recommended by Asian groups and a few European groups as an eff ective therapy for critical ischaemia [5][6][7][8][9]. The results of a contemporar...

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Section: Discussionsupporting

confidence: 79%

Very distal vein bypass in patients with thromboangiitis obliterans

Neufang

Vargas-Gomez

Ewald

et al. 2017

Vasa

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“…Additionally, a failure to obtain complete hemostasis with the use of a tourniquet was observed in 8% of cases in a series of 117 infrainguinal reconstruction procedures. 9 From the economical point of view, these devices have an initial increase of the procedural cost of about $1,650 US.…”

Section: Discussionmentioning

confidence: 99%

Easy alternatives to difficult clamping of distal vessels of the leg

Ysa

Bustabad

Arruabarrena

et al. 2008

Journal of Vascular Surgery

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“…1e3 Other techniques for the creation of a blood-less field include the use of vessel loops, intra-arterial occlusion with balloons or shunts and tourniquet. 4 However, these techniques are also associated with risk of arterial damage, inadequate vascular occlusion and increased technical complexity of the anastomosis in the presence of intraarterial occlusion devices, as well as muscle and nerve damage in case of tourniquet. 3,5 A particular challenge is faced in distal bypass surgery in patients with unclampable calcified infra-popliteal vessels, which are more often present in the expanding cohort of vascular patients with diabetes and chronic renal failure.…”

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confidence: 99%