Optimal methods for autogenous bypass to the anterior tibial artery.
BACKGROUND
Autogenous bypass to the anterior tibial artery (AT) has been increasingly used for infrageniculate revascularization. The conduit may be routed through the interosseous membrane, a pretibial tunnel, or through a lateral thigh and calf tunnel. This study reviewed results of AT bypass to determine the optimal routing method.


METHODS
One hundred thirty consecutive vein grafts to the AT were analyzed retrospectively to compare the experience with the interosseous (group I; n = 50), pretibial (group II; n = 51), and lateral (group III; n = 29) routing alternatives.


RESULTS
Indications were claudication in 16 (12.3%) and critical ischemia in 114 (87.8%) procedures with no differences among routing subgroups. Ectopic nonreversed and composite conduits were more common in group III. Major operative morbidity occurred after 7 procedures (5.4%) with no differences in early graft failure (7.7% overall) among the three routing subgroups. Wound infections were more common among group I patients, but without predilection to the interosseous tunnel. During a mean follow-up of 24.9 months (0 to 111.2) overall 5-year secondary patency was 70% with no difference among routing technique.


CONCLUSIONS
Optimal routing choice depends on the location of suitable AT, the length of adequate vein conduit, and the surgeon's preference rather than on factors inherent to the method used.
Eslami
M H
MH
Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Belkin
M
M
Mannick
J A
JA
Whittemore
A D
AD
Donaldson
M C
MC
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016909:Tibial Arteries / Q000601:surgery*; D014182:Transplantation, Autologous; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation