Limb salvage by inverted Y vein grafts to below-knee arteries

Distal Y branches to other below-knee arteries were added to standard femorotibial bypass grafts to increase runoff, more effectively perfuse the ischemic limb, and improve limb salvage rate. Y grafts were performed in 16 lower limbs in 15 patients. Flow through the graft was increased significantly with each additional Y limb. Preoperative angiograms demonstrated filling of the distal vessels. Surgical indications were gangrenous toes or ischemic ulcers in 12 patients, and 13 limbs were saved. Three patients received bypass grafts for acute ischemic changes, limbs were salvaged in two of the three patients. Two Y grafts performed in 1971 and in 1974 remain patent. Between 1971 and 1977, forty standard femorotibial bypasses were done, with a long-term patency rate of 54%. During the past two years, 13 more Y grafts were performed, with an overall initial patency of 94%. Late results of the Y grafts have been surprisingly good, with no subsequent loss of grafts or limbs.