Eleven-year experience with tibiotibial bypass: an unusual but effective solution to distal tibial artery occlusive disease and limited autologous vein.
OBJECTIVE
The absence of sufficient length of suitable autologous vein occasionally prohibits the treatment of severe distal lower extremity arterial occlusive disease with a standard distal bypass originating from the common femoral artery. During the past 11 years, we have therefore selectively performed short distal bypasses originating from the infrapopliteal arteries in patients with limb-threatening ischemia and occlusive lesions limited to the distal tibial and peroneal arteries. This report summarizes our experience with these tibial artery based distal bypasses.


METHODS
Forty-two distal lower extremity arterial bypasses originating from infrapopliteal arteries in 41 patients were performed over an 11-year period. Autologous vein was used as the bypass conduit in all cases. Extensions from a more proximal bypass were excluded.


RESULTS
The primary patency rate of these tibiotibial bypasses was 77% at 1 year and 62% after 5 years. The limb salvage rate after 5 years was 74%. The perioperative mortality rate was low (2%), but the 5-year patient survival rate (64%) was similar to that with more standard lower extremity arterial reconstructive procedures.


CONCLUSIONS
Tibiotibial bypass is an effective limb salvage procedure in carefully selected patients with distal tibial artery occlusive disease and limited autologous vein. It offers a durable means of distal revascularization in circumstances in which a standard operation might not be desirable or possible.
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10461.
R T
RT
Lyon
F J
FJ
Veith
B U
BU
Marsan
K R
KR
Wengerter
T F
TF
Panetta
M L
ML
Marin
J
J
Goldsmith
S P
SP
Rivers
W
W
Suggs
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D006083:Graft Occlusion, Vascular; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016909:Tibial Arteries / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation