Very distal bypass for salvage of the severely ischemic extremity.

摘要: Forty-six bypass grafts to tibial arteries distal the ankle were performed in 35 patients for salvage of extremities threatened by gangrene or nonhealing ulcers (grade III, category 5) ischemic rest pain II, 4). Most (80%) diabetic, with severely calcified arteries, whom previously we would have considered as candidates primary amputation. All reconstructions autologous saphenous vein. Inflow was from common femoral artery 5 (11%), popliteal 25 (54%), mid-tibial 16 (35%). Life-table analysis used calculate patency and limb salvage. Results analyzed according origin inflow, outflow, configuration conduit ( situ vein, n=29 [63%], reversed n=11 [24%], nonreversed n=6 [13%]). Overall cumulative graft at 2 years all 72%, rate 89% same interval. No significant differences seen comparing originating level those arising arteries. noted among a posterior tibial, dorsalis pedis, plantar outflow. difference between vein grafts. A decreased nonreversed, translocated We conclude that foot vessels are beneficial should be gangrene, ulceration, pain. In our experience, similarly, whereas poorer prognosis. Vessel wall calcification requires modification technique performance these but did not affect long-term salvage, thus contraindication vascular reconstruction. The operative microscope 61% (28 46) cases found useful creating delicate anastomoses. Additional follow-up is needed document results very reconstructions.