An Effective Surgical Technique for Limb Salvage in Femorodistal Bypass

Abstract

Usually, the extension of revascularization of lower extremities to the distal arteries is performed to avoid limb amputation. Technical errors in the performance of the distal anastomosis or poor runoff cause early failure of the bypass; myointimal fibroplasia or new atherosclerosis at the distal suture edges cause long-term failure. A new modified technique was used in 20 patients to facilitate the perform ance of the distal anastomosis. A vein patch is employed to widen the distal arteriotomy, and then, the graft is sutured into the vein patch so that the caliber of the distal artery is increased; potential technical defects and the risk of an early thrombosis are thus avoided. Care is always taken to guarantee a backflow in the vessel, which will permit limb salvage even if the distal runoff is not maintained in long-term follow-up because of occlusion of the outflow. From 1979 to 1985, 20 patients underwent 21 distal arterial reconstructive procedures with this new technique. All patients presented an absolute indica tion for surgery: rest pain (6), gangrene or ulcer (12), and severe ischemia (2). For the bypass procedure, the great saphenous vein was employed in 13 cases and PTFE in 8. Three major amputations were necessary within eight days of the operation. There was no operative mortality. Long-term patency rate was very high (85%).