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Annals of Vascular Surgery

, Volume 3, Issue 3, pp 205–209 | Cite as

In situ bypass to the dorsalis pedis and tibial arteries at the ankle

  • Arnold W. Levine
  • Robert C. Davis
  • Robert O. Gingery
  • Denise D. Anderegg
Papers from the Peripheral Vascular Surgery Society
  • 3 Downloads

Abstract

Over a three-year period (1984–1987), we performed 98 in situ saphenous vein bypasses to the tibial arteries in 89 patients. In 68 of these grafts, the distal anastomoses were above ankle level. All but one of these grafts were performed for limb salvage indications. Seven (10%) of these grafts were done in patients on chronic renal dialysis. In 30 grafts, the distal anastomoses were to the ankle level. Indications for surgery were risk of limb loss in all of these patients, with tissue loss in 29 (97%). Six (20%) were done in patients on chronic renal dialysis. Operative mortality was 3% in both groups. Late mortality was 13% in the above-ankle group, and 27% in the ankle level group. Secondary patency for the above-ankle group was 97%, 85%, 81%, and 81% at 30 days, one year, two years, and three years. Primary patency was 91%, 67%, and 58% at 30 days, one year, and two years, after which the standard error is greater than 10%. Secondary patency for the grafts at the ankle level was 100% and 82% at 30 days and one and one-half years. Primary patency rates were 93% and 68% at 30 days and one year. In situ bypass grafts at the ankle level had patency rates equivalent to grafts with distal anastomoses above the ankle. Patients with distal bypasses usually presented with tissue loss and had a higher late mortality rate. Careful follow-up and operative intervention when changes in graft velocities or indices are recognized, markedly improves the durability of the in situ saphenous vein bypass.

Key words

Arteries tibial arteries dorsalis pedis saphenous vein bypass 

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References

  1. 1.
    LEVINE AW, BANDYK DF, BONIER PH, TOWNE JB. Lessons learned in adopting the in situ saphenous vein bypass.J Vasc Surg 1985;2:145–153.CrossRefPubMedGoogle Scholar
  2. 2.
    BANDYK DF, CATO RF, TOWNE JB. A low flow velocity predicts failure of femoropopliteal and femorotibial bypass grafts.Surgery 1985;98:799–809.PubMedGoogle Scholar
  3. 3.
    CUTLER SJ, EDERER F. Maximum utilization of the life table method in analyzing survival.J Chronic Dis 1958;8:699–712.CrossRefPubMedGoogle Scholar
  4. 4.
    BANDYK DF, KAEBNICK HW, STEWART GW, TOWNE JB. Durability of the in situ saphenous vein arterial bypass: a comparison of primary and secondary patency.J Vasc Surg 1987;5:256–268.CrossRefPubMedGoogle Scholar
  5. 5.
    BUCHBINDER D, PASCH AR, ROLLINS DL, DILLON BC, DOUGLAS DJ, SCHULER JJ, FLANIGAN DP. Results of arterial reconstruction of the foot.Arch Surg 1986;121:673–677.PubMedGoogle Scholar

Copyright information

© Annals of Vascular Surgery Inc. 1989

Authors and Affiliations

  • Arnold W. Levine
    • 1
  • Robert C. Davis
    • 1
  • Robert O. Gingery
    • 1
  • Denise D. Anderegg
    • 1
  1. 1.General Vascular Surgery Medical Group, Inc.Oakland

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