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Prebypass operative arteriography

D P Flanigan, L R Williams, T Keifer

    Surgery
    |October 1, 1982
    PubMed
    Summary
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    Intraoperative arteriography significantly improves limb salvage rates by visualizing previously unseen arteries for bypass grafting in patients with incomplete preoperative imaging. This technique aids in selecting optimal vessels, reducing amputations.

    Area of Science:

    • Vascular Surgery
    • Interventional Radiology
    • Cardiovascular Imaging

    Background:

    • Preoperative arteriography can be incomplete, hindering successful lower extremity arterial bypass grafting.
    • Nonvisualization of patent arterial segments may lead to unnecessary amputations.
    • Many patients requiring bypass are in limb salvage categories, emphasizing the need for accurate preoperative assessment.

    Purpose of the Study:

    • To evaluate the efficacy of intraoperative arteriography in improving arterial visualization for lower extremity bypass grafting.
    • To determine the impact of intraoperative arteriography on limb salvage rates.
    • To assess the utility of operative arteriograms when preoperative studies are inadequate.

    Main Methods:

    • 33 operative arteriograms were performed on 31 patients undergoing lower extremity arterial bypass between 1978 and 1981.

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  • Arteriograms were performed via femoral, popliteal, posterior tibial, or dorsal pedial arteries after arterial dissection and inflow occlusion.
  • Patient data, including bypass success and limb salvage, were analyzed retrospectively.

    • Main Results:

    • Operative arteriography was beneficial in 91% of cases, aiding bypass in 66% to previously unvisualized vessels.
    • In 25% of cases, intraoperative arteriograms provided superior visualization for optimal recipient artery selection.
    • Major amputation was avoided in 86% of patients with severe limb-threatening conditions.

    Conclusions:

    • Prebypass operative arteriography is a valuable technique for enhancing limb salvage in patients with incomplete preoperative arteriographic studies.
    • This method increases the likelihood of successful arterial bypass grafting by improving visualization of recipient vessels and distal runoff.
    • Intraoperative arteriography plays a critical role in limb salvage, particularly for patients facing immediate amputation.