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The dorsalis pedis bypass--moderate success in difficult situations
E B Harrington1, M E Harrington, H Schanzer
1Department of Surgery (Division of Vascular Surgery), Mount Sinai School of Medicine of the City University of New York, New York.
Journal of Vascular Surgery
|February 1, 1992
Summary
Dorsalis pedis bypass offers a modest success rate for limb salvage, particularly in diabetic patients. Factors like vein quality, foot infection, and arch defects impact outcomes, suggesting primary amputation may be better in high-risk cases.
Area of Science:
- Vascular Surgery
- Podiatric Medicine
- Diabetic Foot Care
Background:
- Inframalleolar reconstructions show promise.
- Dorsalis pedis bypass outcomes require further analysis.
Purpose of the Study:
- To review outcomes of dorsalis pedis bypass.
- To identify reasons for graft failure and limb salvage limitations.
Main Methods:
- Retrospective review of 73 dorsalis pedis bypass procedures (1984-1991).
- Analysis of patient demographics, indications, complications, and graft patency.
- Evaluation of factors influencing limb salvage rates.
Main Results:
- 73.5% limb salvage rate and 59.2% primary patency at 2 years.
- Complications included graft failure (29 grafts), foot infection, marginal vein quality, and skin necrosis.
- Failure was linked to deficient anterior arches and extensive foot infections.
Conclusions:
- Dorsalis pedis bypass has a modest success rate, especially in diabetic patients with foot infections.
- Marginal vein quality, poor pedal arches, and severe infections predict poor limb salvage.
- Consider primary amputation for patients with high failure risk.