This paper is only available as a PDF. To read, Please Download here.
Patients with ischemic ulceration of the foot and no continuous tibial or inframalleolar vessels acceptable for bypass are often treated with primary amputation. We have performed autogenous vein bypass to isolated tibial artery segments (ITAS) in nine patients with ischemic foot ulcers and no other outflow options. We reviewed the clinical and hemodynamic results of these bypasses to assess the efficacy of this approach. Hemodynamic comparisons of these ITAS bypasses were made to a concurrent series of 26 bypasses to intact tibial arteries and 24 inframalleolar artery bypasses assessed during routine follow-up. Eight of the bypasses originated from the above-knee popliteal artery and one from the profunda femoris artery. Recipient vessels were the anterior tibial (seven), peroneal (one), and posterior tibial (one) arteries. Although mean ankle brachial indices (ABI) increased significantly from 0.26±0.06 preoperatively to 0.75±0.04 postoperatively (p=0.0015), ITAS bypass patients had lower mean postoperative ABIs than patients with bypasses to intact tibial (ABI=0.98±0.03, p=0.0001) or pedal arteries (ABI=1.02±0.04, p=0.0005). Similarly, duplex scan-derived peak systolic flow velocities of the ITAS bypasses (mean: 52.9±5.8 cm/sec) were lower than those of intact tibial artery bypasses (mean: 80.1±6.1 cm/sec, p=0.02) but did not differ from those of pedal bypasses (mean: 59.5±3.5 cm/sec, p=0.34). No ITAS bypass grafts have failed during a mean follow-up of 12.3±2.7 months. Although wound healing was prolonged (mean: 3.1±0.6 months), the wounds of eight of nine patients eventually healed, with three patients requiring minor amputations (one digital amputation and two transmetatarsal amputations). Although the hemodynamic results of ITAS bypass are inferior to those of more conventional bypasses, the early patency rates and successful healing of ischemic wounds confirm that it is a valid alternative in the threatened limb with no other outflow options.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The American Journal of Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Efficacy of the dorsal pedal bypass for limb salvage in diabetic patients: short-term observations.J Vasc Surg. 1990; 11: 745-752
- Bypass grafts to the ankle and foot.J Vasc Surg. 1988; 7: 785-794
- Bypasses to plantar and other tibial branches: an extended approach to limb salvage.J Vasc Surg. 1988; 8: 434-441
- Success of bypass vein grafts in patients with isolated popliteal artery segments.Surgery. 1967; 61: 17-25
- Variation in vein graft flow velocity with liminal diameter and outflow level.J Vasc Surg. 1992; 15: 991-999
- Femoral distal bypass with in vitu greater saphenous vein.Ann Surg. 1991; 213: 457-463
- Experience with in situ saphenous vein bypasses during 1981–1989: determinant factors of long term patency.J Vasc Surg. 1991; 13: 137-149
- Resurrection of the in situ saphenous vein bypass: 1000 cases later.Ann Surg. 1988; 208: 435-442
- Present status of reversed vein bypass grafting: five-year results of a modern series.J Vasc Surg. 1990; 11: 193-206
- Tibiotibial vein bypass grafts: a new operation for limb salvage.J Vasc Surg. 1985; 2: 552-557
- In situ vein bypasses to distal tibial and limited outflow tracts for limb salvage.Surgery. 1984; 96: 756-763
- Angiographic criteria for successful tibial arterial reconstruction.Surgery. 1973; 74: 830-838
- The superficial femoral and popliteal arteries as inflow sites for distal bypasses.Surgery. 1981; 90: 980-990
**Presented at the 20th Annual Meeting of the Society for ClinicalVascular Surgery, Orlando, Florida, March 25–29, 1992.
© 1992 Reed Publishing USA. Published by Elsevier Inc.