Completion arteriography in paramalleolar bypasses: effect of configurational changes, with special reference to spasm, on long-term outcome.
OBJECTIVE
The purpose of this study was to ascertain the durability of paramalleolar bypasses and elucidate the effect of configurational changes, especially spasm, seen on the completion arteriography upon the outcome.


METHODS
Retrospective study.


METHODS
University hospital experience.


METHODS
Nineteen paramalleolar bypass operations in sixteen patients performed between April 1988 and March 1995 were studied retrospectively. Reversed saphenous vein grafts were used in all cases. One patient required an additional microvascular free flap transfer to cover a foot amputation stump. Seventeen completion arteriograms were obtained. Patients were followed for an average of 37 months.


RESULTS
One patient died in hospital, giving a hospital death rate of 5.9%. Two grafts failed immediately and could not be salvaged. Inadvertent perforation of one graft required partial replacement with a polytetrafluoroethylene graft; it eventually failed after 42 months. There were no other graft failures during follow-up. Nine completion arteriograms showed spastic change of the run-off artery, but this change had disappeared on repeat angiograms obtained before discharge.


CONCLUSIONS
Spasm of run-off artery is a frequent finding in distal bypass surgery and adversely affects the immediate outcome. Heparinization during the first 24 hours after surgery may reduce the consequences of spasm, and long-term patency can be expected providing that the whole graft consists of autogenous vein.
Sato
O
O
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Miyata
T
T
Deguchi
J
J
Sugawara
Y
Y
Kimura
H
H
Tada
Y
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000672:Amputation Stumps / Q000601:surgery; D000792:Angiography; D000842:Ankle / Q000098:blood supply*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001161:Arteriosclerosis / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D013035:Spasm / Q000000981:diagnostic imaging; D013524:Surgical Flaps; D013919:Thromboangiitis Obliterans / Q000601:surgery; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods