Document Detail

Vein bypasses to branches of pedal arteries.
MedLine Citation:
PMID:  22209614     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We report a retrospective analysis of our experience in bypass vein graft surgery to lateral tarsal, medial plantar, and lateral plantar arteries for treatment of critical limb ischemia (CLI).
METHODS: Between January 1991 and February 2010, we performed 137 inframalleolar bypass graft surgeries; of these, 25 (18%) were conducted using foot branch arteries for distal implant. All patients were treated for CLI and most had extensive infrapopliteal atherosclerotic disease (TransAtlantic Inter-Society Consensus D). Mean follow-up was 46.32 months (range, 0-144 months). Main end points analyzed were cumulative patency, limb salvage, and survival. Statistic analysis of all end points was performed using Kaplan-Meier survival curves.
RESULTS: There was a predominance of men (64%), and the group mean age was 66.3 years. Diabetes mellitus was the main associated disease. Eighty percent of ulcers or gangrene were restricted to the midfoot (Rutherford V CLI classification). There was a predominance of short-length grafts using the great saphenous vein as the main conduit (72%). The medial plantar artery was the main outflow artery (52%). Early graft occlusion occurred in four patients (primary failure rate, 16%). Secondary patency at 1 and 3 years was 49% and 36.8%, respectively, and limb salvage was 81.7% and 69%, respectively. Nine major amputations occurred, and 10 other minor amputations were necessary. Survival rate at 3 years was 65.4%, and 67% of patients maintained ambulation. Surgical mortality was 8%. No condition was associated with worse results with regard to secondary patency, limb salvage, or survival.
CONCLUSIONS: Long-term results for developed foot branch bypass demonstrated good results for limb salvage, and it is an acceptable surgery for patients with extensive atherosclerotic disease.
Francisco Cardoso Brochado-Neto; Marcus Vinícius Martins Cury; Suellen Stevam Timotheo Bonadiman; Marcelo Fernando Matielo; Sérgio Roberto Tiossi; Marcos Roberto Godoy; Katsumi Nakano; Roberto Sacilotto
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Publication Detail:
Type:  Journal Article     Date:  2011-12-30
Journal Detail:
Title:  Journal of vascular surgery     Volume:  55     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-28     Completed Date:  2012-05-01     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:  746-52     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Department of Vascular Surgery, Hospital Servidor Publico Estadual, São Paulo, SP, Brazil.
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MeSH Terms
Aged, 80 and over
Arteries / physiopathology,  surgery
Atherosclerosis / mortality,  physiopathology,  radiography,  surgery*
Chi-Square Distribution
Critical Illness
Graft Occlusion, Vascular / etiology,  physiopathology,  surgery
Ischemia / mortality,  physiopathology,  radiography,  surgery*
Kaplan-Meier Estimate
Limb Salvage
Lower Extremity / blood supply*
Middle Aged
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Saphenous Vein / transplantation
Survival Rate
Time Factors
Treatment Outcome
Vascular Grafting* / adverse effects,  mortality
Vascular Patency

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