Efficacy of the dorsal pedal bypass for limb salvage in diabetic patients: short-term observations.
Limbs of diabetic patients with distal tibial disease are frequently considered unreconstructible; however, when studied with intraarterial digital subtraction angiography, the dorsal pedal artery is frequently found to be patent. We have reviewed our recent experience with 96 patients, 94% of whom had diabetes and had 97 bypasses placed to the dorsal pedal artery. All procedures were for limb salvage. Superimposed infection was present in 42.3%. In 92 instances where intraarterial digital subtraction angiography successfully visualized the dorsal pedal artery, 91 bypasses were placed. In 12 other cases where the dorsal pedal artery was not visualized by intraarterial digital subtraction angiography but audible with the continuous-wave Doppler, bypasses were completed successfully in six. All procedures were performed with vein. Inflow was taken from the femoral artery in 48, popliteal artery in 45, tibial artery in 2, and from a femoral tibial graft in 2. Perioperative mortality was 1.92%. Actuarial graft patency, limb salvage, and patient survival were 82%, 87%, and 80%, respectively at 18 months. We conclude that bypass grafting to the dorsal pedal artery can be reliably performed with acceptable short-term results. An attempt should always be made to visualize the foot vessels angiographically, especially in diabetic patients, so that this valuable option in arterial reconstruction will not be overlooked.
Pomposelli
F B
FB
Division of Vascular Surgery, New England Deaconess Hospital, Harvard Medical School, Boston, MA.
Jepsen
S J
SJ
Gibbons
G W
GW
Campbell
D R
DR
Freeman
D V
DV
Miller
A
A
LoGerfo
F W
FW
D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D011150:Popliteal Artery / Q000601:surgery; D012501:Saphenous Vein / Q000637:transplantation