title: In-situ bypass surgery on arteriographically invisible vessels detected by Doppler-ultrasound for limb salvage.
abstract: OBJECTIVE
  The aim of this paper was to evaluate our primary experience with bypass surgery on arteries only visible on Doppler-ultrasound in patients suffering from critical lower limb ischemia.
  
  
  METHODS
  During a study period of 10 months, Doppler-ultrasound routinely supplemented digital subtraction arteriography (DSA) whenever it failed to reveal patent runoff vessels suitable for in-situ saphenous vein bypass surgery. If an arteriographically invisible runoff artery was detected on Doppler-ultrasound and the patient was eligible for surgery, a bypass procedure was performed. All patients were facing a lower limb amputation due to critical limb ischemia (tissue loss, SVS/ISCV-category 5). Postoperatively the patients were followed according to a standard graft surveillance program, including clinical examination, ankle pressure measurements and a color Doppler-ultrasound at discharge and after 1, 6 and 12 months.
  
  
  RESULTS
  Fifty-one in-situ saphenous vein bypasses were performed, 5 (10%) on arteriographically occult runoff vessels detected only on Doppler-ultrasound. After a 12-month follow-up, 3 bypasses were still patent and only one patient had an amputation. One bypass occluded after 6 months but the patient stayed asymptomatic.
  
  
  CONCLUSIONS
  Doppler-ultrasound permits in-situ by-pass surgery on arteriographically invisible vessels reducing the proportion of inoperable patients by 10%.
authors.affiliation: Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark. jonas@eiberg.org
authors.forename: J P
authors.initials: JP
authors.lastname: Eiberg
authors.forename: M A
authors.initials: MA
authors.lastname: Hansen
authors.forename: L G
authors.initials: LG
authors.lastname: Jørgensen
authors.forename: J B G
authors.initials: JB
authors.lastname: Rasmussen
authors.forename: F
authors.initials: F
authors.lastname: Jensen
authors.forename: T V
authors.initials: TV
authors.lastname: Schroeder
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000637:transplantation; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency; D014656:Vascular Surgical Procedures