Femorotibial Bypass Grafts Research Articles

Treatment of Vein Graft Stenosis by Balloon Catheter Dilation

Percutaneous balloon catheter dilation was used to treate 12 high-grade stenoses in ten autogenous vein bypass grafts since September 1978. Four lesions occurred in femoropopliteal grafts, seven in femorotibal grafts, seven in femorotibial grafts, and one in an axillofemoral graft. Balloon catheter dilation was successful and surgery avoided in 11 of the 12 lesions. Pedal pulses were restored in eight of the ten patients, and the pulse in a femorotibial bypass graft was improved in another. Postdilation arteriography demonstrated a substantial increase in luminal diameter, and ankle pressure indexes were improved in all successful cases. The tenth had an operative correction of the stenosis. There were no complications with the procedure. Percutaneous balloon catheter dilation appears to be an effective method of treating stenosis in autogenous vein grafts and a useful alternative to surgical revision.

Limb salvage by inverted Y vein grafts to below-knee arteries.

Distal Y branches to other below-knee arteries were added to standard femorotibial bypass grafts to increase runoff, more effectively perfuse the ischemic limb, and improve limb salvage rate. Y grafts were performed in 16 lower limbs in 15 patients. Flow through the graft was increased significantly with each additional Y limb. Preoperative angiograms demonstrated filling of the distal vessels. Surgical indications were gangrenous toes or ischemic ulcers in 12 patients, and 13 limbs were saved. Three patients received bypass grafts for acute ischemic changes, limbs were salvaged in two of the three patients. Two Y grafts performed in 1971 and in 1974 remain patent. Between 1971 and 1977, forty standard femorotibial bypasses were done, with a long-term patency rate of 54%. During the past two years, 13 more Y grafts were performed, with an overall initial patency of 94%. Late results of the Y grafts have been surprisingly good, with no subsequent loss of grafts or limbs.

Whole limb femoral arteriography: Importance in selection of patients for femorotibial bypass grafting

Femorotibial bypass grafting is an effective means of salvaging limbs in selected patients. Broader applicability of this operation depends on the availability of whole limb serial femoral arteriography for case selection. A simple and readily adaptable method of whole limb arteriography is presented. Using this method of arteriography, a new clinical classification of occlusive disease of the femoral arterial system is proposed.