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Current techniques for infrainguinal arterial reconstruction.

A Whittemore1

  • 1Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115.

The Japanese Journal of Surgery
|November 1, 1990
PubMed
Summary

Autogenous saphenous vein bypass offers durable infrainguinal reconstruction for peripheral vascular disease, achieving excellent limb salvage. Secondary interventions improve outcomes when grafts fail, but prosthetic materials show poor long-term results.

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The vascular center at Brigham and Women's Hospital.

Cardiovascular surgery (London, England)·1998

Area of Science:

  • Vascular Surgery
  • Peripheral Vascular Disease Management

Background:

  • Infrainguinal reconstruction is crucial for limb salvage in peripheral vascular occlusive disease.
  • Conventional autogenous saphenous vein bypass is the most durable revascularization method.

Purpose of the Study:

  • To review infrainguinal reconstruction options for peripheral vascular occlusive disease.
  • To highlight the efficacy of autogenous saphenous vein bypass and emerging interventions.

Main Methods:

  • Review of conventional autogenous saphenous vein bypass efficacy.
  • Assessment of secondary intervention outcomes.
  • Evaluation of new percutaneous transluminal angioplasty, rotary atherectomy, and laser devices.

Main Results:

  • Autogenous saphenous vein bypass demonstrates high patency (80% at 5 years) and limb salvage rates, even at infrapopliteal/inframalleolar levels.
  • Secondary interventions achieve sustained limb salvage in most patients after graft failure.
  • Prosthetic materials perform poorly; new endovascular devices show encouraging initial results but poor long-term patency due to restenosis.

Conclusions:

  • Autogenous saphenous vein bypass remains the gold standard for infrainguinal reconstruction.
  • Understanding arterial healing is key to improving outcomes with new endovascular interventions and reducing restenosis.

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