Document Detail

Bypass to the perigeniculate collateral vessels. A useful technique for limb salvage: preliminary report on 22 patients.
MedLine Citation:
PMID:  9620146     Owner:  NLM     Status:  MEDLINE    
PURPOSE: We describe our initial experience with the use of perigeniculate vessels as outflow tracts in infrainguinal revascularizations for critical limb ischemia.
METHODS: Twenty-two such reconstructions were carried out in 20 patients over a 2-year period. Indications for surgery consisted of tissue loss in 9 patients and rest pain in the other 13 patients. Inflow was obtained from the femoral vessels. A variety of graft materials were used, including saphenous vein (16 patients), polytetrafluoroethylene (2 patients), composite (1 patient), and arterial homografts (3 patients). The perigeniculate vessels used were the medial sural artery to the gastrocnemius (arteria suralis) in 16 patients and the highest genicular artery (arteria genu suprema) in the other 6 patients. These vessels were approached via a medial above-the-knee popliteal-type exposure.
RESULTS: There were three postoperative deaths. Mean follow-up for the other 17 patients averaged 12 months (range, 3 to 37 months). Three grafts failed (thrombosis) during follow-up, leading to two above-the-knee amputations. One graft stenosis was treated with percutaneous angioplasty. The average postoperative increase in the ankle-brachial index was 0.20.
CONCLUSION: These early results appear promising with a 1-year primary patency rate of 77%, assisted primary patency rate of 85%, and a limb-salvage rate of 90% according to the Kaplan-Meier life-table method. This technique is particularly useful when adequate length saphenous vein is not available, no other outflow vessels are available, or other outflow vessels are very calcified and not safely clamped. The continued study of the long-term effectiveness is warranted.
X Barral; G R Salari; B Toursarkissian; J P Favre; J P Gournier; P Reny
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  27     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-06-29     Completed Date:  1998-06-29     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  928-35     Citation Subset:  IM    
Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Saint-Etienne, France.
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MeSH Terms
Angioplasty, Balloon
Arterial Occlusive Diseases / surgery*
Arteries / surgery
Blood Pressure / physiology
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
Collateral Circulation / physiology*
Femoral Artery / surgery
Follow-Up Studies
Graft Occlusion, Vascular / etiology
Ischemia / surgery*
Knee / blood supply*,  surgery
Life Tables
Muscle, Skeletal / blood supply
Popliteal Artery / surgery
Regional Blood Flow / physiology
Saphenous Vein / transplantation
Survival Rate
Thrombosis / etiology
Vascular Patency
Reg. No./Substance:

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