title: Bypass to the genicular arteries for revascularisation of the lower limb.
abstract: OBJECTIVE
  To describe an initial experience with infrainguinal bypass grafts inserted distally in a genicular artery.
  
  
  METHODS
  Retrospective case series study.
  
  
  METHODS
  Eleven patients with Grade III chronic limb ischaemia in whom arteriography showed femoropopliteal occlusive disease and at least one genicular branch suitable for receiving a bypass. Bypass grafts were done to the descending genicular artery (n=4) or the medial sural artery (n=6) using segments of autologous veins; one bypass was not completed.
  
  
  RESULTS
  Primary graft patency and foot salvage rates were 73% at 1 month and 24 months of follow-up. Patient survival rate was 100% and 90%, respectively. Major amputation was required in two of three patients following early graft failure. Of the eight patients who had a patent graft, the Doppler ankle-brachial systolic pressure index showed no change in one patient, an increase of 0.13-0.66 in six patients, and was not measured in one patient. The former patient underwent a below-knee amputation whereas the other seven patients showed complete healing of their skin ulcers and sites of minor amputation.
  
  
  CONCLUSIONS
  The genicular bypass is a useful alternative that may extend the limits of infrainguinal arterial reconstruction with autologous tissue and the potential for long-term patient benefit.
authors.affiliation: Vascular Surgery Section, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, Brazil.
authors.forename: F C
authors.initials: FC
authors.lastname: Brochado Neto
authors.forename: J
authors.initials: J
authors.lastname: Gonzalez
authors.forename: M
authors.initials: M
authors.lastname: Cinelli
authors.forename: M
authors.initials: M
authors.lastname: Albers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000601:surgery; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007717:Knee / Q000098:blood supply*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D014680:Veins / Q000637:transplantation*