Tourniquet occlusion technique for tibial artery reconstruction

Wagner, Willis H.; Treiman, Richard L.; Cossman, David V.; Cohen, Jordan L.; Foran, Robert F.; Treiman, Gerald S.; Levin, Phillip M.

doi:10.1016/0741-5214(93)90073-u

Cited by 29 publications

(19 citation statements)

References 47 publications

(9 reference statements)

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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: 74%

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: 74%

Very distal vein bypass in patients with thromboangiitis obliterans

Neufang

Vargas-Gomez

Ewald

et al. 2017

Vasa

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“…The tourniquet occlusion technique was used to obtain a bloodless field and minimize the isolation. 7 Another approach for reducing the degree of operative injury would be to incise the dilated popliteal vein to close the fistula. The dilated vein was located just above the artery in the operative field.…”

Section: Discussionmentioning

confidence: 99%

Recovery of Cardiomegaly After Treatment of Traumatic Popliteal Arteriovenous Fistula

Shindo

Honda

Katsu

et al. 2009

Circ J

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Circ J 2009; 73: 776 -778 raumatic arteriovenous fistula (AVF) occurs infrequently after arterial injury. 1 Although the initial symptoms are frequently mild, the shunt flow increases with time and the patient becomes aware of a thrill or swelling over the affected area. Cardiac symptoms are eventually noted when compensation cannot cover the increased cardiac load. However, AVF in the extremity rarely leads to cardiac failure because the artery affected is relatively small. We describe a patient who was treated surgically for a long-standing popliteal AVF, in whom cardiomegaly promptly resolved after the operation. We also discuss the etiology and technical aspects of the treatment. Case ReportA 32-year-old man visited hospital complaining of swelling of the left leg, particularly below the knee. He had also noted redness, local heat and skin pigmentation. Nine years before, he had been involved in a traffic accident and had suffered a compound fracture of the left tibia with bone exposure. The fracture had been stabilized using a metal plate and nails, and since then he had been asymptomatic. However, several years later, he became aware of swelling of the left leg, which had gradually increased. The current presentation occurred after another traffic accident, which was not severe.Physical examination revealed marked swelling and skin pigmentation of the left leg below the knee and a thrill in the popliteal fossa. The patient complained of heaviness in the left leg, but was otherwise asymptomatic and had no shortness of breath. Chest roentgenography revealed cardiomegaly with a cardiothoracic ratio (CTR) of 61% (Figure 1A). Ultrasonic cardiography (UCG) revealed normal cardiac function with an ejection fraction (EF) of 77%, although the left atrium and ventricle were enlarged (Table). Enhanced computed tomography revealed distinct enlargement of the popliteal vein with early enhancement (Figure 2A) Recovery of Cardiomegaly After Treatment of Traumatic Popliteal Arteriovenous FistulaShunya Shindo, MD; Yoshihiro Honda, MD; Masatake Katsu, MD; Shigeaki Kaga, MD; Hidenori Inoue, MD; Masahiko Matsumoto, MD Circulatory distress can occur in the long term after the formation of a traumatic arteriovenous fistula (AVF), but cardiac failure rarely occurs in a patient with an AVF in the lower extremity. The present patient underwent surgery to treat a traumatic popliteal AVF 9 years after sustaining the injury. Although the patient was asymptomatic with regard to cardiac circulation, cardiomegaly was noted and it resolved promptly after the surgical treatment. Cardiac insufficiency should be borne in mind even when a patient is asymptomatic because young patients have a high tolerance for cardiac overload. CASE REPORT

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“…Da gleichzeitig mit dem Hochrollen der Manschette das venöse System im Sinne einer Blutleere entleert, bzw. ausgerollt wird, ist das Risiko venöser Thrombosen relativ gering [5,11,14,15]. Nachteile bestehen im Versagen der Manschette durch kalzifizierte Gefäße oder ein Abgleiten.…”

Section: Pneumatisches Clamping In Der Distalen Bypasschirurgieunclassified

“…Seit ihrer Einführung in den 80er-Jahren ist diese Methode kaum bekannt und wird weiterhin sehr kontrovers diskutiert [1,2,6]. Vor allem im deutschsprachigen Schrifttum finden sich außer Wagner [15] und Schroeder einschließlich ihrer Mitarb. [11] …”

Section: Diskussionunclassified

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Pneumatische Tourniquet-Blutstromunterbrechung in der distalen Bypasschirurgie

Hanzlick¹

2006

Zentralbl Chir

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The femoral-popliteal or distal bypass requires as a rule exact isolation and dissection of the arteriosclerotic and calcified artery. The tourniquet is an effective substitute for vascular occlusion especially in case of seriously calcified vessels. As opposed to the Esmarch bandage, the sterile Löfquist-bandage has a lot of advantages. Starting the bypass operation as usual procedure the Löfquist-bandage can be used for interruption of circulation just before opening the vessels. Positive experiences in varicose vein surgery induced us to perform this tourniquet procedure in distal bypass surgery by using the special Löfquist-bandage. Meanwhile we operated on 74 patients between 1999 and 2003. We treated 29 patients with primary distal bypass reconstruction and 45 patients who suffered from bypass occlusion. In addition to bypass thrombectomy, these patients underwent PTA, reconstructions of the distal anastomosis and bypass prolongations. The advantages were both a short clamping time and an economic dissection of the vessels. The complications were haematomas, re-occlusion, wound infections and major amputations in only few patients. Operative complications with the bandage were not observed. Indications, important technical details and the results are critically discussed.

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Tourniquet occlusion technique for tibial artery reconstruction

Cited by 29 publications

References 47 publications

Very distal vein bypass in patients with thromboangiitis obliterans

Very distal vein bypass in patients with thromboangiitis obliterans

Recovery of Cardiomegaly After Treatment of Traumatic Popliteal Arteriovenous Fistula

Pneumatische Tourniquet-Blutstromunterbrechung in der distalen Bypasschirurgie

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