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Walter J. McCarthy, MD, William H. Pearce, MD, William R

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Presentation on theme: "Walter J. McCarthy, MD, William H. Pearce, MD, William R"— Presentation transcript:

1 Long-term evaluation of composite sequential bypass for limb-threatening ischemia 
Walter J. McCarthy, MD, William H. Pearce, MD, William R. Flinn, MD, Gregory S. McGee, MD, Roger Wang, BS, James S.T. Yao, MD, PhD  Journal of Vascular Surgery  Volume 15, Issue 5, Pages (May 1992) DOI: / (92)90710-P Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

2 Fig. 1 Anastomosis of PTFE material above the knee is ideal. Venous conduit is then used to most proximal tibial vessel providing patency to foot. Journal of Vascular Surgery  , DOI: ( / (92)90710-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

3 Fig. 2 Popliteal anastomosis with PTFE does not require substantial runoff. In this case, an endarterectomy provided an extremely blind segment. Nevertheless, extended patency of distal anastomosis was achieved and maintained. Journal of Vascular Surgery  , DOI: ( / (92)90710-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

4 Fig. 3 Lesser saphenous vein is easily located midway between lateral malleolus and Achilles tendon. An initial incision between these two landmarks is then extended along the vein into posterior calf. Journal of Vascular Surgery  , DOI: ( / (92)90710-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

5 Fig. 4 Composite sequential format allows lesser saphenous vein to be used for far distal reconstructions. Anastomosis to posterior tibial artery just above the ankle allowed perfusion for toe amputation healing. Journal of Vascular Surgery  , DOI: ( / (92)90710-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

6 Fig. 5 In situ management of lesser saphenous vein is possible with proximal anastomosis anastomosed to a PTFE graft in below-knee popliteal position. This in situ bypass provided flow to peroneal artery. Journal of Vascular Surgery  , DOI: ( / (92)90710-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

7 Fig. 6 Prosthetic grafting to below-knee popliteal may be necessary because of arterial anatomy or lack of available vein length. Making the middle two anastomoses nearly adjacent will maximize flow through entire PTFE graft. Journal of Vascular Surgery  , DOI: ( / (92)90710-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

8 Fig. 7 Cumulative life table primary patency. The standard error remained less than 10% until after 48 months (dotted line). Journal of Vascular Surgery  , DOI: ( / (92)90710-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

9 Fig. 8 Retained patency of distal venous segment has been demonstrated frequently after proximal PTFE thrombosis. This extremity was studied with digital subtraction angiography as compared with its full patency 2 years before on completion arteriogram (Fig. 9). Retained distal patency facilitates technical repair. Journal of Vascular Surgery  , DOI: ( / (92)90710-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

10 Fig. 9 Completion arteriogram after bypass related to foot gangrene. Same patient as in Fig. 8. Journal of Vascular Surgery  , DOI: ( / (92)90710-P) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

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