Radial artery flow-through graft: a new conduit for limb salvage.
OBJECTIVE
Patients with severe peripheral occlusive disease may present especially challenging problems because of previous bypass surgery, location of ulcers, or extremely poor runoff. We used the radial artery with its overlying skin flap as a bypass conduit, called the radial artery flow-through (RAFT) graft in 10 such patients.


METHODS
From November 1999 to January 2002, 10 patients had limb-threatening ischemia at presentation. All had severe inframalleolar vascular occlusive disease. Four patients had undergone previous conventional bypass procedures. Two grafts remained patent, but distal ulcers failed to heal. Eight patients were men. Seven patients had diabetes mellitus. All patients but one had nonhealing ulcers. In most cases, a composite femoral-tibial bypass graft was constructed by sewing the RAFT graft end-to-end to either the greater saphenous vein or, in one patient, to a polytetrafluoroethylene graft. In all cases, the radial venous comitans were sewn to a nearby superficial vein. In 5 patients the skin paddle was positioned to cover the ulcer; in the remaining patients the skin paddle was used to close the foot incision over the distal anastamosis. Postoperative graft surveillance was performed with Duplex scanning or contrast medium-enhanced angiography.


RESULTS
Thromboses developed in 2 grafts during follow-up. In 1 of these patients below-knee amputation was performed. Another patient required below-knee amputation because of continuing infection in the foot despite a patent RAFT graft. In 1 patient thrombosis developed in the vein graft, but the RAFT graft extension remained patent. All other RAFT grafts were patent in their entirety at 15 (+/-6) months.


CONCLUSIONS
The RAFT graft is a new option for treating limb-threatening ischemia. The skin paddle may be useful in selected patients for wound coverage.
Teodorescu
Victoria J
VJ
Division of Vascular Surgery, The Mount Sinai Medical Center, New York, NY 10029-6574, USA. victoria.teodorescu@mountsinai.org
Chun
Jin K
JK
Morrisey
Nicholas J
NJ
Faries
Peter L
PL
Hollier
Larry H
LH
Marin
Michael L
ML
D000368:Aged; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D017534:Radial Artery / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply* / Q000639:trends; D013927:Thrombosis / Q000209:etiology / Q000601:surgery; D014945:Wound Healing