Extrinsic Band as an Unusual Cause of an Intermittent Graft Obstruction (original) (raw)
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American journal of surgery, 1994
Short vein grafts originating from sites distal to the common femoral artery have been reported to be useful in selected patients with tibial artery disease. From 1987 to 1993, we performed 504 consecutive infrainguinal vein bypass grafts, of which 56 (11%) originated from the popliteal artery, 25 above and 31 below the knee. The patients were 16 women and 37 men, with a mean age of 62.4 years. Eighty-seven percent were diabetic, 57% had clinically obvious coronary artery disease, and 28% had end-stage renal disease (ESRD). The indication for surgery was ulceration or gangrene in 93% of cases. We preferentially used reversed greater saphenous vein harvested from the thigh to optimize conduit quality and avoid lower leg wound complications. The outflow artery sites were: dorsal pedal (17), posterior tibial (14), peroneal (10), anterior tibial (8), lateral or medial plantar (5), and sequential tibial (2). All patients were followed postoperatively with serial duplex surveillance. The ...
Annals of Surgery, 1990
, we treated 2829 patients with critical lower-extremity ischemia. In the last 5 years, 13% of patients had therapeutically significant stenoses or occlusions above and below the groin, while 35% had them at two or three levels below the inguinal ligament. Unobstructed arterial flow to the distal half of the thigh was present in 26% of patients, and 16% had unobstructed flow to the upper third of the leg with occlusions of all three leg arteries distal to this point and reconstitution of some patent named artery in the lower leg or foot. In the last 2 years, 99% of all patients with a threatened limb and without severe organic mental syndrome or midfoot gangrene were amenable to revascularization by percutaneous transluminal angioplasty (PTA), arterial bypass, or a combination of the two, although some distal arteries used for bypass insertion were heavily diseased or isolated segments without an intact plantar arch. Limb salvage was achieved and maintained in more than 90% of recent patient cohorts, with a mean procedural mortality rate of 3.3%. Recent strategies that contributed to these results include (1) distal origin short vein grafts from the belowknee popliteal or tibial arteries to an ankle or foot artery (291 cases); (2) combined PTA and bypass (245 cases); (3) more distal PTA of popliteal and tibial artery stenoses (233 cases); (4) use of in situ or ectopic reversed autogenous vein for infrapopliteal bypasses, even when vein diameter was 3 to 4 mm; (5) compositesequential femoropopliteal-distal (PTFE/vein) bypasses; (6) reintervention when a procedure thrombosed (637 cases) or was threatened by a hemodynamically significant inflow, outflow, or graft lesion (failing graft, 252 cases); (7) frequent follow-up to detect threatening lesions before graft thrombosis occurred and to permit correction of lesions by PTA (58%) or simple reoperation; and (8) unusual approaches to all infrainguinal arteries to facilitate secondary operations, despite scarring and infection. Primary major amputation rates decreased from 41% to 5% and
Analysis of Flow Changes to the Foot after Sacrifice of One of the Major Arteries
Journal of Reconstructive Microsurgery, 2009
The objective of this study was to find out whether a compensatory increase in blood flow to the foot is observed after sacrifice of one of the tibial arteries. Eleven patients who had one of the tibial arteries as the recipient artery of free tissue transfer to their lower extremities were included. The arterial diameter, cross-sectional area, maximum flow velocity, minimum flow velocity, and flow rate were measured by a Doppler ultrasound in the nonrecipient tibial artery and perforating peroneal artery in the operated limb. The same parameters were measured in the anterior and posterior tibial arteries and the perforating peroneal artery in the contralateral limb. The arterial diameter, cross-sectional area, flow velocity, and flow rate were increased significantly in the nonrecipient tibial artery of the operated limb with respect to the same artery on the contralateral limb. The same changes were not demonstrated in the perforating branch of the peroneal artery. Total blood flow to the foot in the operated extremity was not different from that of the nonoperated foot. The results reveal that if a major feeder to the foot is sacrificed, the other tibial artery compensates for it, and resting blood supply to the foot is not altered.
Surgical Anatomy of the Veins of the Lower Limb
Perspectives in Vascular Surgery, 2000
Introduction: With the advent of new surgical techniques, an adequate knowledge of precise anatomy of the venous system of the lower limb is important for safe surgery. The aim of this study is to provide some basic information for those who are interested in phlebology. Materials and methods: The anatomy of the superficial and deep veins of both lower limbs was studied in 20 human cadavers (age 42-72 years) of both sexes (12 males: 08 females). Great saphenous vein (GSV) and small saphenous vein (SSV) were traced from medial and lateral malleoli to the sapheno-femoral junction (SFJ) and saphenopopliteal junction (SPJ) respectively. The number of deep perforators was counted and measurements were taken from a fixed anatomical land mark. Results: In both lower limbs of 17 cadavers (85%), the course of GSV was similar to the course described in the commonly used text books. Large tributary with a diameter similar to GSV at the SFJ was seen in 3 cadavers (15%). The point of entry of SSV into the popliteal vein varied greatly. In majority of cadavers the opening was at the level of the popliteal skin crease and in others it was either above or below this. Large deep perforators were found in the calf and thigh with irregularly distributed small perforators. Conclusion: A majority of individuals have the lower limb superficial venous pattern described in standard text books. However, a significant minority had variations, which could have important implications on the presentation and treatment of varicose veins.