Skip to main content
SpringerLink
Log in

Surgical Revascularization

  • Chapter
Peripheral Arterial Disease

Part of the book series: Contemporary Cardiology ((CONCARD))

  • 194 Accesses

Abstract

Indications for vascular surgical reconstruction for peripheral arterial disease (PAD) generally include two clinical presentations: intermittent claudication (IC) and critical limb ischemia (CLI), which includes rest pain, nonhealing ulcers, and gangrene. Prior to any consideration of intervention for IC, lifestyle modification including an exercise program, smoking cessation, weight loss, correction of hyperlipidemia, and a trial of pharmacologic agents is essential. Recent studies have demonstrated that abnormal levels of homocysteine and antiphospholipid antibodies not only can contribute to PAD, but also affect graft function and patency, thereby warranting medical treatment (1–5). Patients with CLI, however, without a lumen-opening intervention and/or surgical revascularization will almost certainly be faced with a major limb amputation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Boushey CJ, Beresford SA, Omenn GS, Motulsky AG. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease: probable benefits of increasing folic acid intakes. JAMA 1995; 274: 1049–1057.

    Article  PubMed  CAS  Google Scholar 

  2. Criqui MH, Denenberg JO, Langer RD, Fronek A. The epidemiology of peripheral arterial disease: importance of identifying the population at risk. Vasc Med 1997; 2: 221–226.

    PubMed  CAS  Google Scholar 

  3. Ridker PM, Stampfer MJ, Rifai N. Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA 2001; 285: 2481–2485.

    Article  PubMed  CAS  Google Scholar 

  4. Taylor LM, Moneta GL, Sexton GJ, Schuff RA, Porter JM. Prospective blinded study of the relationship between plasma homocysteine and progression of symptomatic peripheral arterial disease. J Vasc Surg 1999; 29: 8–19.

    Article  PubMed  Google Scholar 

  5. Lam EY, Taylor LM, Landry GJ, Porter JM, Moneta GL. Relationship between antiphospholipid antibodies and progression of lower extremity arterial occlusive disease after lower extremity bypass operations. J Vasc Surg 2001; 33: 976–982.

    Article  PubMed  CAS  Google Scholar 

  6. DeVries SO, Hunink MGM. Results of aortic bifurcation grafts for aortoiliac occlusive disease: a meta-analysis. J Vasc Surg 1997; 26: 558–569.

    Article  CAS  Google Scholar 

  7. Amwli FM, Stein M, Aro L, Provan JL, Gray R, Grossman H. End-to-end vs end-to-side proximal anastomosis in aortobifemoral bypass surgery: does it matter Can J Surg 1991; 34: 243–246.

    Google Scholar 

  8. Cormio L, Edgren J, Lepantalo M, et al. Aortofemoral surgery and sexual function. Eur J Vasc Endovasc Surg 1996; 11: 453–457.

    Article  PubMed  CAS  Google Scholar 

  9. Sicard GA, Reilly JM, Rubin BG, et al. Transabdominal versus retroperitoneal incision for abdominal aortic surgery: report of a prospective randomized trial. J Vasc Surg1995; 21: 174–183.

    CAS  Google Scholar 

  10. Cambria RP, Brewster DC, Abbott WM, et al. Transperitoneal versus retroperitoneal approach for aortic reconstruction J Vasc Surg 2000; 11: 314–325.

    Google Scholar 

  11. Passman MA, Taylor LM, Moneta GL et al. Comparison of axillofemoral and aortofemoral bypass for aortoiliac occlusive disease. J Vasc Surg 1996; 23: 263–271.

    Article  PubMed  CAS  Google Scholar 

  12. Rutherford RB, Patt A, Pearce WH. Extraanatomic bypass: a closer look. J Vasc Surg 1987; 6: 437–446.

    PubMed  CAS  Google Scholar 

  13. Calligaro KD, Ascer E, Veith FJ, et al. Unsuspected inflow disease in candidates for axillofemoral bypass operations: a prospective study. J Vasc Surg 1990; 11: 832–837.

    PubMed  CAS  Google Scholar 

  14. Harris JE, Taylor LM, McConnell DB, Moneta GL, Yeager RA, Porter JM. Clinical results of axillofemoral bypass using externally supported polytetrafluoroethylene. J Vasc Surg 1990; 12: 416–421.

    Article  PubMed  Google Scholar 

  15. Darling RC, Leather RP, Chang BB, Lloyd WE, Shah DM. Is the iliac artery a suitable inflow conduit for iliofemoral occlusive disease? An analysis of 514 aortoiliac reconstructions. J Vasc Surg 1990; 12: 409–415.

    Google Scholar 

  16. van den Dungen JJAN, Boontje JA, Kriveld A. Unilateral iliofemoral occlusive disease: long-term results of the semiclosed endarterectomy with the ring stripper. J Vasc Surg 1991; 14: 673–677.

    Article  PubMed  Google Scholar 

  17. Kalmar PG, Hoserg M, Johnston KW. The current role for femorofemoral bypass. J Vasc Surg 1987; 6: 71–76.

    Article  Google Scholar 

  18. Flanagan P, Pratt DG, Goodrean JJ. Hemodynamic and angiographic guidelines in selection of patients for femorofemoral bypass. J Vasc Surg1987; 6: 71–76.

    Article  Google Scholar 

  19. Griffith CDM, Callum KG. Limb salvage surgery in a district general hospital: factors affecting outcome. Ann Coll Surg (Engl) 1988; 70: 95–98.

    CAS  Google Scholar 

  20. Norgen L, Alwmark A, Angqvist KA, et al. A stable prostacyclin analogue (Iloprost) in the treatment of ischemic ulcers of the lower limb: a Scandinavian-Polish placebo-controlled randomized multicenter study. Eur J Vasc Surg 1991; 4: 463–467.

    Article  Google Scholar 

  21. Muluk SC, Muluk VS, Kelley ME, et al. Outcome events in patients with claudication: a 15-year study in 2777 patients. J Vasc Surg 2001; 33: 251–258.

    Article  PubMed  CAS  Google Scholar 

  22. Newman AB, Shemanski L, Manolio TA, et al. Ankle-arm index as a predictor of cardiovascular disease and mortality in the cardiovascular health study. Arterioscler Thromb Vasc Biol 1999; 19: 538–545.

    Article  PubMed  CAS  Google Scholar 

  23. Moore KL. The lower limb. In: Moore KL, ed. Clinically Oriented Anatomy, 2nd edit. Baltimore: Williams and Wilkins, 1985; pp. 396–564.

    Google Scholar 

  24. Madiba TE, Mars M, Robbs JV. Aortobifemoral bypass in the presence of superficial femoral artery occlusion: does the profunda femoris artery provide adequate runoff J R Coll Surg (Edinb) 1998; 43: 310–313.

    CAS  Google Scholar 

  25. Prendiville EJ, Burke PE, Colgan MP, Wee BL, Moore DJ, Shanik DG. The profonda femoris: a durable outflow vessel in aortofemoral surgery. J Vasc Surg 1992; 16: 23–29.

    Article  PubMed  CAS  Google Scholar 

  26. Bastounis E, Felekouras E, Pikoulis E, Hadjinikolaou L, Georgopoulos S, Balas P. The role of profunda femoris revascularization in aortofemoral surgery: an analysis of factors affecting graft patency. Int Angiol 1997; 16: 107–113.

    PubMed  CAS  Google Scholar 

  27. van der Plas JP, Dijk J, Tordoir JH, Jacobs MJ, Kitslaar PJ. Isolated profundaplasty in critical limb ischemia: still of any use Eur J Vasc Surg 1993; 7: 54–58.

    Article  PubMed  Google Scholar 

  28. Panayiotopoulos YP, Reidy JF, Taylor PR. The concept of knee salvage: why does a failed femorocrural/pedal arterial bypass not affect the amputation level Eur J Vasc Endovasc Surg 1997; 14: 417–418.

    Article  Google Scholar 

  29. Byrne J, Darling C, Chang BB, et al. Infrainguinal arterial reconstructions for claudication: is it worth the risk? An analysis of 409 procedures. J Vasc Surg 1999; 29: 259–269.

    Article  PubMed  CAS  Google Scholar 

  30. Menzoian JO, LaMorte WW, Paniszyn CC, et al. Symptomatology and anatomic patterns of peripheral vascular disease: differing impact of smoking and diabetes. Ann Vasc Surg 1989; 3: 224–228.

    Article  PubMed  CAS  Google Scholar 

  31. Shah DM, Darling RC, Chang BB, Fitzgerald KM, Paty PS, Leather RP. Long-term results of in situ saphenous vein bypass: analysis of 2058 cases. Ann Surg 1995; 222: 438–446.

    PubMed  CAS  Google Scholar 

  32. Johnson WC, Lee KK. A comparative evaluation of polytetrafluoroethylene, umbilical vein, and saphenous vein bypass grafts for femoral-popliteal above-knee revascularizations: a prospective randomized Department of Veterans Affairs Cooperative Study. J Vasc Surg 2000; 32: 268–277.

    Article  PubMed  CAS  Google Scholar 

  33. Burger DHC, Kappetein AP, van Bockel H, Breslau PJ. A prospective randomized trial comparing vein with polytetrafluoroethylene in above-knee femoropopliteal bypass grafting. J Vasc Surg 2000; 32: 278–283.

    Article  PubMed  CAS  Google Scholar 

  34. Post S, Kraus T, Muller-Reinartz U, et al. Dacron vs. polytetrafluoroethylene grafts for femoropopliteal bypass: a prospective randomized multicenter trial. Eur J Vasc Endovasc Surg 2001; 22: 226–231.

    Article  PubMed  CAS  Google Scholar 

  35. Green RM, Abbott WM, Matsumoto T, et al. Prosthetic above-knee femoropopliteal bypass grafting: five year results of a randomized trial. J Vasc Surg 2000; 31: 417–425.

    Article  PubMed  CAS  Google Scholar 

  36. Weitz JI, Byrne J, Clagett GP, et al. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review. Circulation 1996; 94: 3026–3049.

    Article  PubMed  CAS  Google Scholar 

  37. Samson RH, Showalter DP, Yunis JP. Isolated femoropopliteal bypass graft for limb salvage after failed tibial reconstruction: a viable alternative to amputation. J Vasc Surg 1999; 29: 409–412.

    Article  PubMed  CAS  Google Scholar 

  38. Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo IM. Association of peri-operative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery: the Study of Perioperative Ischemia Research Group. N Engl J Med 1990; 323: 1781–1788.

    Article  PubMed  CAS  Google Scholar 

  39. de Virgilio C, Toosie K, Ephraim L, et al. Dipyridamole-thallium/sestamibi before vascular surgery: a prospective blinded study in moderate-risk patients. J Vasc Surg 2000; 32: 77–89.

    Article  PubMed  Google Scholar 

  40. Schwartz ME, Harrington EB, Schanzer H. Wound complications after in situ bypass. J Vasc Surg 1988; 7: 802–807.

    PubMed  CAS  Google Scholar 

  41. Clark TW, Groffsky JL, Soulen MC. Predictors of long-term patency after femoropopliteal angioplasty: results from the STAR registry. J Vasc Intery Radiol 2001; 12: 923–933.

    Article  CAS  Google Scholar 

  42. Karch LA, Mattos MA, Henretta PJ, McLafferty RB, Ramsey DE, Hodgson KJ. Clinical failure after percutaneous transluminal angioplasty of the superficial femoral and popliteal arteries. J Vasc Surg 2000; 31: 880–887.

    Article  PubMed  CAS  Google Scholar 

  43. Lofberg AM, Karacagil S, Ljungman C, et al. Percutaneous transluminal angioplasty of the femoropopliteal arteries in limbs with chronic critical lower limb ischemia. J Vase Surg 2001; 34: 114–121.

    Article  CAS  Google Scholar 

  44. Parsons RE, Suggs WD, Lee JJ, Sanchez LA, Lyon RT, Veith FJ. Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: do the results justify an attempt before bypass grafting J Vasc Surg 1998; 28: 1066–1071.

    Article  PubMed  CAS  Google Scholar 

  45. TASC Working Group. Management of peripheral arterial disease (PAD). J Vasc Surg 2000; 31: S1 - S296.

    Article  Google Scholar 

  46. Nelson PR, Powell RJ, Proia RR, et al. Results of endovascular superficial femoral endarterectomy. J Vasc Surg 2001; 34: 526–531.

    Article  PubMed  CAS  Google Scholar 

  47. Verhelst R, Bruneau M, Nicolas AL, et al. Popliteal-to-distal bypass grafts for limb salvage. Ann Vasc Surg 1997; 11: 505–509.

    Article  PubMed  CAS  Google Scholar 

  48. Rosenbloom MS, Walsh JJ, Shuler JJ, et al. Long-term results of infragenicular bypasses with autogenous vein originating from the distal superficial femoral and popliteal arteries. J Vasc Surg 1988; 7: 691–696.

    PubMed  CAS  Google Scholar 

  49. Mills JL, Taylor SM, Fujitani RM. The role of the deep femoral artery as an inflow site for infrainguinal revascularization. J Vasc Surg 1993; 18: 416–423.

    Article  PubMed  CAS  Google Scholar 

  50. Faries PL, Arora S, Pomposelli FB, et al. The use of arm vein in lower-extremity revascularization: results of 520 procedures performed in eight years. J Vasc Surg 2000; 31: 50–59.

    Article  PubMed  CAS  Google Scholar 

  51. Ascer E, Veith FJ, Gupta SK. Bypasses to plantar arteries and other tibial branches: an extended approach to limb salvage. J Vasc Surg 1988; 8: 434–441.

    PubMed  CAS  Google Scholar 

  52. Roddy SP, Darling RC, Chang BB, et al. Outcomes with plantar bypass for limb-threatening ischemia. Ann Vasc Surg 2001; 15: 79–83.

    PubMed  CAS  Google Scholar 

  53. Darling RC, Chang BB, Shah DM, Leather RP. Choice of peroneal or dorsalis pedis artery bypass for limb salvage. Semin Vasc Surg 1997; 10: 17–22.

    PubMed  Google Scholar 

  54. Belkin M, Knox J, Donoldson MC, Mannick JA, Whittemore AD. Infrainguinal arterial reconstruction with nonreversed greater saphenous vein. J Vasc Surg 1996; 24: 957–962.

    Article  PubMed  CAS  Google Scholar 

  55. Eugster T, Stierli P, Aeberhard P. Infrainguinal arterial reconstructions with autologous vein grafts: are the results for the in situ technique better than those of non-reversed bypass? A long-term follow-up study. J Cardiovasc Surg (Torino) 2001; 42: 221–226.

    CAS  Google Scholar 

  56. Watelet J, Soury P, Menard JF, Plissonnier D, Peillon C, Lestrat JP Femoropopliteal bypass: in situ or reversed vein grafts? Ten-year results of a randomized prospective study. Ann Vasc Surg 1997; 11: 510–519.

    Article  PubMed  CAS  Google Scholar 

  57. Taylor RS, Loh A, McFarland RJ, Cox M, Chester JE Improved technique for polytetrafluoroethylene bypass grafting: long-term results using anastomotic vein patches. Br J Surg 1992; 79: 348–354.

    Article  PubMed  CAS  Google Scholar 

  58. Stonebridge PA, Prescott RJ, Ruckley CV. Randomized trial comparing infrainguinal polytetrafluoroethylene bypass grafting with and without vein interposition cuff at the distal anastomosis: the joint vascular research group. J Vasc Surg 1997; 26: 543–550.

    Article  PubMed  CAS  Google Scholar 

  59. Kansal N, Pappas PJ, Gwertzman GA, et al. Patency and limb salvage for polytetrafluoroethylene bypasses with vein interposition cuffs. Ann Vasc Surg 1999; 13: 386–392.

    Article  PubMed  CAS  Google Scholar 

  60. Neville RF, Tempesta B, Sidawy AN. Tibial bypass for limb salvage using polytetrafluoroethylene and a distal vein patch. J Vasc Surg 2001; 33: 266–272.

    Article  PubMed  CAS  Google Scholar 

  61. Kreienberg PB, Darling RC, Chang BB, Paty PS, Lloyd WE, Shah DM. Adjunctive techniques to improve patency of distal prosthetic bypass grafts: polytetrafluoroethylene with remote arteriovenous fistulae versus vein cuffs. J Vasc Surg 2000; 31: 696–701.

    Article  PubMed  CAS  Google Scholar 

  62. Hamsho A, Nott D, Harris PL. Prospective randomized trial of distal arteriovenous fistula as an adjunct to femoro-infrapopliteal PTFE grafts. Eur J Vasc Endovasc Surg 1999; 17: 197–201.

    Article  PubMed  CAS  Google Scholar 

  63. Bastounis E, Georgopoulos S, Maltezos C, Alexiou D, Chiotopoulos D, Bramis J. PTFE-vein composite grafts for critical limb ischemia: a valuable alternative to all-autogenous infrageniculate reconstructions. Eur J Vasc Endovasc Surg 1999; 18: 127–132.

    Article  PubMed  CAS  Google Scholar 

  64. Faries PL, LoGerfo FW, Arora S, et al. Arm vein conduit is superior to composite prosthetic-autogenous grafts in lower extremity revascularization. J Vasc Surg 2000; 31: 1119–1127.

    PubMed  CAS  Google Scholar 

  65. Owen WF, Madore F, Brenner BM. An observational study of cardiovascular characteristics of longterm end-stage renal disease survivors. Am J Kidney Dis 1996; 28: 931–936.

    Article  PubMed  CAS  Google Scholar 

  66. Peri UN, Fenvez AZ, Middleton JR Improving survival of octogenarian patients selected for hemodialysis. Nephrol Dial Transplant 2001; 16: 2201–2206.

    Article  PubMed  CAS  Google Scholar 

  67. Baek MY, Kwon TH, Kim YL, Cho DK. CAPD, an acceptable form of therapy in elderly ESRD patients: a comparative study. Adv Perit Dial 1997; 13: 158–161.

    PubMed  CAS  Google Scholar 

  68. Hakaim AG, Gordon JK, Scott TE. Early outcome of in situ femorotibial reconstruction among patients with diabetes alone versus diabetes and end-stage renal failure: analysis of 83 limbs. J Vasc Surg 1998; 27: 1049–1055.

    Article  PubMed  CAS  Google Scholar 

  69. Harrington EB, Harrington ME, Schanzer H, Haimov M. End-stage renal disease: is infrainguinal limb revascularization justified J Vasc Surg 1990; 12: 691–696.

    Article  PubMed  CAS  Google Scholar 

  70. Edwards JM, Taylor LM, Porter JM. Limb salvage in end-stage renal disease (ESRD): comparison of modern results in patients with and without ESRD. Arch Surg 1988; 123: 1164–1168.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. James O. Menzoian MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph D. Raffetto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Medicine, Boston University Medical Center, Boston, MA, USA

    Jay D. Coffman MD  & Robert T. Eberhardt MD  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer Science+Business Media New York

About this chapter

Cite this chapter

Menzoian, J.O., Raffetto, J.D. (2003). Surgical Revascularization. In: Coffman, J.D., Eberhardt, R.T. (eds) Peripheral Arterial Disease. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-331-6_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-331-6_13

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-326-8

  • Online ISBN: 978-1-59259-331-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation