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Related Experiment Videos

Ankle bypass: should we go the distance?

D Buchbinder, A R Pasch, M J Verta

    American Journal of Surgery
    |August 1, 1985
    PubMed
    Summary

    Distal arterial reconstructions using popliteal-to-distal and in situ bypass techniques show promising early results for limb salvage in patients with critical limb ischemia. In situ saphenous vein bypass demonstrated superior patency and limb salvage rates.

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    Area of Science:

    • Vascular Surgery
    • Reconstructive Surgery
    • Peripheral Arterial Disease

    Background:

    • Critical limb ischemia (CLI) often necessitates surgical intervention for limb salvage.
    • Distal arterial reconstructions below the malleolus are challenging procedures.
    • Diabetic patients and those with gangrene represent a significant proportion of CLI cases.

    Purpose of the Study:

    • To review the outcomes of distal arterial reconstructions in patients undergoing popliteal-to-distal bypass and in situ bypass.
    • To evaluate the effectiveness of these techniques for limb salvage in CLI.
    • To compare the patency and limb salvage rates between different bypass methods.

    Main Methods:

    • Retrospective review of 47 distal arterial reconstructions performed below the malleolus.

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  • Procedures included popliteal-to-distal bypass (n=20) and in situ saphenous vein bypass (n=27).
  • Analysis of patient demographics, indications (gangrene, ischemic ulceration), and surgical outcomes (patency, limb salvage).

    • Main Results:

    • Popliteal-to-distal bypass with reversed saphenous vein: 92% patency at 24 months, 57% at 60 months; 70% limb salvage at 60 months.
    • Popliteal-to-distal bypass with PTFE: 53% patency at 12 months, 0% at 36 months; 53% limb salvage at 36 months.
    • In situ saphenous vein bypass: 96% patency at 24 months, 80% limb salvage at 24 months.

    Conclusions:

    • Both popliteal-to-distal and in situ bypass techniques can achieve limb salvage in CLI.
    • In situ saphenous vein bypass demonstrated excellent early patency and limb salvage rates.
    • Further investigation into long-term outcomes is warranted for these distal bypass procedures.