Document Detail

Challenges of distal bypass surgery in patients with diabetes: patient selection, techniques, and outcomes.
MedLine Citation:
PMID:  20804940     Owner:  NLM     Status:  MEDLINE    
Surgical revascularization of the lower extremity using bypass grafts to distal target arteries is an established, effective therapy for advanced ischemia. Recent multicenter data confirm the primacy of autogenous vein bypass grafting, yet there remains significant heterogeneity in the utilization, techniques, and outcomes associated with these procedures in current practice. Experienced clinical judgment, creativity, technical precision, and fastidious postoperative care are required to optimize long-term results. The patient with diabetes and a critically ischemic limb offers some specific challenges; however, numerous studies demonstrate that the outcomes of vein bypass surgery in this population are excellent and define the standard of care. Technical factors, such as conduit, and inflow/outflow artery selection play a dominant role in determining clinical success. An adequate caliber, good quality great saphenous vein (GSV) is the optimal graft for distal bypass in the leg. Alternative veins perform acceptably in the absence of GSV, whereas prosthetic and other non-autogenous conduits have markedly inferior outcomes. Graft configuration (reversed, non-reversed, or in situ) seems to have little influence on outcome. Shorter grafts have improved patency. Inflow can be improved by surgical or endovascular means if necessary, and distal-origin grafts (eg, those arising from the superficial femoral or popliteal arteries) can perform as well as those originating from the common femoral artery. The selected outflow vessel should supply unimpeded runoff to the foot, conserve conduit length, allow for adequate soft tissue coverage of the graft, and simplified surgical exposure. This review summarizes the available data linking patient selection and technical factors to outcomes, and highlights the importance of surgical judgment and operative planning in the current practice of infrainguinal bypass surgery.
Michael S Conte
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  52     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-31     Completed Date:  2010-09-27     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:  96S-103S     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Society for Vascular Surgery and the American Podiatric Medical Association. Published by Mosby, Inc. All rights reserved.
Division of Vascular and Endovascular Surgery, University of California-San Francisco, San Francisco, CA 94143, USA.
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MeSH Terms
Diabetic Angiopathies / physiopathology,  surgery*
Ischemia / physiopathology,  surgery*
Lower Extremity / blood supply*
Patient Selection
Peripheral Vascular Diseases / physiopathology,  surgery*
Risk Assessment
Time Factors
Transplantation, Autologous
Treatment Outcome
Vascular Patency
Vascular Surgical Procedures* / adverse effects
Veins / transplantation*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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