COMPOSITE SEQUENTIAL BYPASSES FOR MULUTI-SEGMENTAL ARTERIOSCLEROSIS OBLITERANS

Abstract

A sequential arterial bypass has been recommended as the surgical treatment for severe lower limb ischemia in patients with complex multi-segmental arterial occlusion. To evaluate this alternative technique clinically, sequential grafting was performed on 14 limbs; 14 patients with the manifestations of intermittent claudication (2), rest pain (8) and nonhealing ulcers (4). Sequential aortofemoro-popliteal bypass grafting was performed on 7 limbs, ilio-femoro-popliteral bypass grafting on 3 limbs and femore-femoral crossover-popliteal bypass grafting and femoro-popliteral-posterior tibial bypass grafting on 2 limbs each. Among the 14 patients, one died in the perioperative period from cardicac arrest and another succumbed to renal failure 57 months after surgery. A total graft occlusion of the sequential graft occurred in two patients during the 57 month follow-up period. One patient (22 months after a sequential bypass) showed a symptomatic remission while undergoing a conservative therapy, but the another (7 months after operation) required an amputation below the knee. Measurement of the segmental Doppler arterial pressure revealed a significant increase in the ankle brachial index from 0.31±0.22 before the operation to 0.83±0.17 three weeks after the operation. Ten limbs showed a remission in the clinical symptoms, while 2 limbs showed no change during the 57 month follow-up period. Sequential bypass grafting is considered to be a useful alternative method for limb preservation.