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Composite sequential bypass using profunda vein hitchhike
Radhakrishnan Raju1, Kapil Mathur1, Makkathai Kanakasabai Ayyappan1
1Department of Vascular Surgery, Sri Ramachandra University, Porur, Chennai, India.
Insights
This study introduces a novel technique using the profunda vein as a hitchhike point for bypass surgery in patients with critical limb ischemia. This method offers excellent short-to-medium term outcomes for a challenging patient subgroup.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Ischemia Management
Background:
- Long-segment iliac and femoral artery occlusions often require sequential bypass.
- A subset of patients lacks suitable groin vessels for traditional bypass.
- Critical limb ischemia necessitates innovative surgical solutions.
Purpose of the Study:
- To evaluate the efficacy of using the profunda vein as a hitchhike point for arterial bypass.
- To assess outcomes in patients with iliac/aortic occlusions and absent groin inflow.
- To present a new surgical technique for a challenging vascular reconstruction.
Main Methods:
- Seven patients (eight limbs) with critical ischemia underwent bypass using the profunda vein as a hitchhike point.
- Proximal graft anastomosis to the profunda vein, which was ligated proximally.
- Distal saphenous vein graft anastomosed to tibial arteries.
Main Results:
- The profunda vein hitchhike technique was technically successful in all cases.
- Median follow-up was 8 months (range 0-30 months).
- Excellent short and medium-term outcomes were observed.
Conclusions:
- The profunda vein hitchhike technique is a viable option for specific patients with critical limb ischemia.
- This method provides a successful reconstructive solution when groin vessels are unavailable.
- It offers excellent outcomes in this uncommon patient population.
Abstract:
Patients with long-segment occlusions of the iliac and femoral arteries often undergo sequential bypass procedures. There exists a subgroup of patients who have no suitable vessels in the groin. We report our experience with a new technique of using the profunda vein as a hitchhike point in our series of seven patients (eight limbs) with critical ischemia and occlusion at the iliac or aortic level with reformation of infrageniculate arteries and no reformation in the groin. The proximal graft was anastomosed to the profunda vein, which was ligated proximal to the anastomosis. The saphenous vein graft was taken from the distal end of the polytetrafluoroethylene graft and anastomosed to the appropriate tibial arteries. The procedure was technically successful in all the patients. The median follow-up was 8 months (range, 0-30). The profunda vein as a hitchhike point gives an excellent outcome in the short and medium term in this uncommon group of patients.
