Tibial Artery Revascularization Utilizing Microscopic Vascular Technique

Abstract

During the past six years and nine months, tibial artery revasculariza tion was performed for 42 cases (47 limbs) utilizing the transmicroscopic vascular technique. The operations for limb salvage of the clinical stages III and IV accounted for 89.4% of all operations. Fifty-two operations were per formed in all, including 3 secondary and 1 tertiary operative procedures. Each distal anastomosis on a tibial artery was completed with a continu ous polypropylene 7-0 suture with the aid of an operative microscope, mag nifying by 5 to 10 times. The greater saphenous vein was used as bypass and patch materials in all cases. Of 37 bypasses, classical reversed graft was adopted for 33 bypasses, includ ing 7 sequential bypasses, while 4 by passes were the in situ graft. Com bined revascularization was per formed simultaneously for 6 limbs and secondarily for 7 limbs for the purpose of improving the inflow. Forty-two cases were successfully followed up for one to eighty-one months postoperatively (24.1 months in average). There was neither opera tive death nor hospital death, but late death due to malignant tumor and thrombotic disease occurred in 5 cases. Early bypass occlusion was ob served in 1 limb and late occlusion in 9 limbs. In 4 limbs with late occlu sion, blood flow was restored satis factorily by additional operation. Amputation was performed on 1 limb with late occlusion. The primary cu mulative patency rate by Kaplan- Meier curve was 95.6% for six months, 85.0% for one year, and 65.0% for five years. The secondary rate was 95.6%, 87.7%, and 84.2% respectively. The transmicroscopic surgical technique can positively reduce anas tomotic troubles during revascular ization of infrapopliteal vessels, and it appears that this technique is a use ful means of maintaining the long term patency of the bypass to infra popliteal vessels and, together with sequential bypass or the combined operation, to the inflow.