Femoral to Posterior Tibial/Peroneal Artery In Situ Bypass

Abstract

The hallmark of in situ bypasses is to leave the vein in its bed, in situ, to minimize the damage and ischemia that can occur during vein harvesting. Furthermore it provides for a better size match between the bypass and the target infrapopliteal vessels. The disadvantages include the risk of trauma from the valvulotomy and a higher incidence of wound complications. Wound complications increase the vulnerability of the vein bypass to thrombosis, desiccation and disruption if it becomes exposed. Various methods have been devised to construct an in situ bypass. Similarly various valvulotomes are available to disrupt the valves, and various techniques are available to occlude the venous branches which if left alone can progress to become arteriovenous fistulae. The procedure described here is the preferred method used at the University of Iowa. This method involves exposing the entire vein, arterializing the vein, using the retrograde Mills valvulotome to disrupt the valves under direct vision and constructing the distal anastomosis.