Abstract
The concept of composite grafts for revascularization of the ischemic lower extremity has been reported on numerous occasions. We have utilized this technique for approximately 8 years as an alternative for those patients who do not have an adequate length of autogenous vein for bypass grafting. We have studied composites utilizing Gore-Tex and umbilical vein for the prosthetic portion with autogenous saphenous vein, cephalic vein, or endarterectomized superficial femoral artery. Subsequent evaluation has led us to discontinue the use ofendarterectomized superficial femoral artery, as we believe that this is not a satisfactory autogenous component. Whenever possible, satisfactory angiograms are obtained prior to tibial bypass surgery; when this is not possible, intraoperative angiograms are utilized to demonstrate distal tibial circulation and to determine the site of distal anastomosis. Two, and sometimes three, operating teams are employed to minimize operating time, with one team constructing the prosthetic autogenous vein anastomosis on a separate table. Improved magnification, such as 21/2 • power magnification, is used in all cases. For the composite anastomosis and all tibial anastomoses, meticulous technique utilizing fine sutures in the form of 6-0 and 7-0 Prolene is stressed. The tibial vessels are handled in an atraumatic fashion using either vessel loops or intraluminal occluders and avoiding the use of clamps. We have stressed technique in harvesting the autogenous vein, utilizing atraumatic dissection, and irrigation of the graft with gradual distention not to exceed 100 mm Hg with a solution of heparinized autogenous whole blood containing papaverine. After harvesting, the grafts are stored in the same solution at 4 ° C. Following completion of the distal tibia] anastomosis, angiograms are performed in each case. No effort has been made to procure sufficient length of autogenous material to cover the crossing of the joint surface, as this has not proved a
Published Version
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