Temporary ex vivo posterior tibial artery bypass for iliofemoral artery injury.
BACKGROUND
The objective of this study is to report a temporary, ex vivo, distal extremity revascularization technique providing distal perfusion and allowing for a staged repair of complex iliofemoral injury. In addition, the objective of this report is to provide outcome data after this novel procedure including mortality, limb salvage, and quality of limb assessment.


METHODS
From February 1993 to December 2005, temporary ex vivo posterior tibial artery revascularization from the uninjured (donor) to the injured extremity was performed in 14 patients. All patients had blunt iliofemoral artery injury with class III or IV hemorrhagic shock. An end-to-end anastomosis between the two posterior tibial arteries was performed. Muscle strength of both legs was measured using the Medical Research Council scale and grade 5 means normal strength.


RESULTS
The mean age at surgery was 35 years+/-7.4 years (mean+/-SD). All patients with ipsilateral legs survived. Patency of the bypass was achieved in all cases. At a mean time of 30 days+/-10 days after injury, the injured iliofemoral artery was reconstructed, and the bypass was transected 7 days later. At the final follow-up, the muscle strength of both legs was of grade 5 based on Medical Research Council scale. Static two-point discrimination test scores were similar on both feet.


CONCLUSIONS
Temporary ex vivo revascularization of the posterior tibial artery is a feasible option in selecting patients with blunt iliofemoral artery injury with ischemia and severe physiologic derangements. This unconventional method provides extremity perfusion distal to the injury and maintains neuromuscular viability during an interval period, allowing for a staged, proximal revascularization after improvement in the patient's physiologic condition.
Microsurgery Department, The Second Hospital of Qinhuangdao, Hebei, People's Republic of China. ahand@sina.com
Xu
X
Zhang
Chenglin
C
Li
Shumin
S
Wen
Hongwei
H
Zhu
Quanfeng
Q
Sheng
Xinzhong
X
Shao
Xu
X
Mi
D000328:Adult; D005260:Female; D005263:Femoral Artery / Q000293:injuries* / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000293:injuries* / Q000601:surgery; D008297:Male; D011182:Postoperative Care / Q000379:methods; D016909:Tibial Arteries / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods*