title: Limb salvage using bypass to the perigeniculate arteries.
abstract: OBJECTIVE
  To describe bypass to perigeniculate vessels for limb salvage.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Between 1995 and 2009, 47 bypass procedures to perigeniculate collateral arteries were performed in 46 patients (15 women, 31 men; median age, 68 years). All patients presented with critical ischaemia (tissue loss in 87.5%, rest pain in 12.5%). Mean ankle brachial index was 0.27 ± 0.17. The site of distal anastomosis was the descending genicular artery (DGA) in 23 bypasses (1 bilateral) and the medial sural artery (MSA) in 24. Proximal anastomosis was to the external iliac artery in 2 cases, common femoral artery in 23 cases, superficial femoral artery in 8 cases, deep femoral artery in 8 cases, above-knee poplitaeal artery in 2 cases, and previous graft in 4 cases.
  
  
  RESULTS
  There were four deaths during the immediate postoperative period. Mean follow-up duration was 27 months. Ten patients required major amputation. Mean ankle brachial index post-operatively was 0.60 ± 0.21. At 3 years, primary patency was 74.7 ± 7%, secondary patency was 83.4 ± 8%, and the limb salvage and survival rates were 73.5 ± 7% and 77.4 ± 7%, respectively.
  
  
  CONCLUSIONS
  Bypass to perigeniculate arteries is a viable treatment option for critical limb ischaemia in selected patients.
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. nluccia@uol.com.br
authors.forename: N
authors.initials: N
authors.lastname: De Luccia
authors.forename: P
authors.initials: P
authors.lastname: Sassaki
authors.forename: A
authors.initials: A
authors.lastname: Durazzo
authors.forename: G
authors.initials: G
authors.lastname: Sandri
authors.forename: M
authors.initials: M
authors.lastname: Kikuchi
authors.forename: C
authors.initials: C
authors.lastname: Hirata
authors.forename: M
authors.initials: M
authors.lastname: Romiti
authors.forename: R
authors.initials: R
authors.lastname: Sacilotto
authors.forename: F C
authors.initials: FC
authors.lastname: Brochado-Neto
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D007717:Knee / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D058729:Peripheral Arterial Disease / Q000601:surgery*; D012189:Retrospective Studies