Bypass grafts to the ankle and foot.
Two hundred forty-three bypasses to paramalleolar arteries were performed in 224 extremities of 208 patients since 1971; 166 were implanted in men (68%) and 77 in women (32%). The median age was 73 years. Gangrene (61%), nonhealing ulcer (15%), rest pain (22%), and trauma (2%) were the indications for bypass. Usual risk factors were noted: diabetes (65%), smoking (51%), heart disease (46%), and hypertension (45%). The extent of occlusive disease dictated three graft configurations: long grafts originating in arteries proximal to the adductor tendon (n = 111), short grafts originating at or below the popliteal artery (n = 88), and jump grafts originating near the distal end of a previous femorodistal bypass (n = 44). The association between diabetes (incidence 80%) and gangrene (75%) in patients with short grafts was statistically significant (p less than 0.01). The 2-year secondary patency rate of long in situ grafts was 92% compared with 72% for other autogenous vein long grafts. The limb salvage rate for all autogenous vein long grafts was 90% at 3 years. The secondary patency rate at 3 years for short grafts was 81% and the limb salvage rate was 80%. There were four amputations with patent grafts. Primary and secondary patency rates of jump grafts were similar (53%), whereas the limb salvage rate was 89% at 2 years. Patency and limb salvage rates of rarely employed nonautogenous conduits were less than 35% at 1 year (long grafts). Bypass grafts to the ankle and foot are effective and durable and should be performed with autogenous vein.
Andros
G
G
Vascular Laboratory, Saint Joseph Medical Center, Burbank, CA 91505.
Harris
R W
RW
Salles-Cunha
S X
SX
Dulawa
L B
LB
Oblath
R W
RW
Apyan
R L
RL
D000368:Aged; D000842:Ankle / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D005260:Female; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D008297:Male; D012307:Risk Factors; D014654:Vascular Patency