Alternative Approaches to the Deep Femoral, Popliteal, and Infrapopliteal Arteries in the Leg and Foot: Part II

Abstract

Use of the nonstandard, alternative approaches to infrainguinal arteries described in this article has made possible the salvage of many ischemie lower extremities that would otherwise be extremely difficult or impossible to revascularize. Most of these were in the increasing proportion of patients whose limb-threatening ischemia occurred after a primary arterial reconstruction had failed. In this setting the unusual alternative approaches facilitated secondary operations that could be performed without the need to redissect arteries through a scarred or infected wound. These approaches have also permitted shorter bypasses and thereby allowed us to use autogenous vein in patients who might otherwise have required a prosthetic graft. This is particularly important for bypass procedures that extend to infrapopliteal arteries, since vein graft patency is so much better in this location. Therefore these alternative approaches have assumed increasing importance and utility in our practice. We believe that they will be equally helpful to others as more vascular surgeons accept the premise that most limb-threatening lower extremity ischemia can and should be treated by arterial reconstruction rather than by amputation.