TY - JOUR
T1 - Bypass to the perigeniculate collateral vessels. A useful technique for limb salvage
T2 - Preliminary report on 22 patients
AU - Barral, X.
AU - Salari, G. R.
AU - Toursarkissian, B.
AU - Favre, J. P.
AU - Gournier, J. P.
AU - Reny, P.
N1 - Funding Information:
Supported by a grant from the Nebraska Affiliate of the American Heart Association to J. J. Grange and a grant from the Pacific Vascular Foundation and the VA merit review to B. T. Baxter.
PY - 1998
Y1 - 1998
N2 - 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.
AB - 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.
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U2 - 10.1016/S0741-5214(98)70274-5
DO - 10.1016/S0741-5214(98)70274-5
M3 - Article
C2 - 9620146
AN - SCOPUS:0031853119
VL - 27
SP - 928
EP - 935
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
SN - 0741-5214
IS - 5
ER -