Bypass to the perigeniculate collateral arteries: mid-term results

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Peripheral Artery Disease

Background:

• Infrainguinal revascularization is crucial for limb salvage in patients with peripheral artery disease.
• Limited options exist for distal anastomosis in complex cases.
• Perigeniculate collateral arteries offer alternative targets for bypass grafting.

Purpose of the Study:

• To evaluate the mid-term outcomes of infrainguinal bypass procedures utilizing the highest genicular artery or medial sural artery.
• To assess the patency and limb salvage rates associated with these distal anastomosis sites.

Main Methods:

• A retrospective review of 59 infrainguinal bypass procedures in 57 patients (1996-2005).
• Distal anastomosis performed to the highest genicular artery (n=18) or medial sural artery (n=37).
• Patients predominantly presented with critical limb ischemia (CLI) (n=55).

Main Results:

• Mean follow-up was 35 months.
• At 3 years, primary patency was 65%, secondary patency was 70%.
• Limb salvage rate was 90% and survival rate was 64%.

Conclusions:

• Bypass grafting to perigeniculate collateral arteries (highest genicular or medial sural arteries) is a viable option for infrainguinal revascularization.
• These procedures offer acceptable patency and high limb salvage rates in patients with CLI.
• Utilizing these collateral arteries can be a valuable strategy when traditional distal targets are unavailable.