Genesis of Crural Revascularization
Thomas R Bernik1, Melissa Montoya1, Brian M Leoce1
1Department of Vascular Surgery, Englewood Hospital and Medical Center, Englewood, NJ.
Annals of Vascular Surgery
|February 23, 2019
Summary
Pioneering surgeons advanced limb salvage through crural bypass surgery between 1960-1979, achieving significant patency rates. These foundational open procedures remain vital alongside modern endovascular techniques for successful limb preservation.
Area of Science:
- Vascular Surgery
- Limb Salvage Procedures
- Arterial Revascularization
Background:
- Focuses on historical development of crural bypass for limb salvage when distal arterial blockage is limited to crural vessels.
- Highlights the evolution of crural bypass amidst the rise of endovascular interventions.
Observation:
- Reviews literature from 1960-1979 to identify pioneers in infrageniculate revascularization.
- Documents patency and amputation rates from early distal limb bypass series.
- Separately records cases from the era not published until the 1980s.
Findings:
- Analyzed 746 crural bypasses performed between 1960-1979.
- Reported 6-, 12-, and 36-month patency rates of 76%, 59%, and 48%, respectively.
- Observed an overall amputation rate of 17% during this period.
Implications:
- Early crural bypass procedures demonstrated satisfactory progress, paving the way for future refinements.
- Recognizes the enduring importance of historical open surgical techniques in limb salvage.
- Emphasizes the complementary role of established bypass surgery with contemporary endovascular methods.
