title: A novel reverse thermosensitive polymer to achieve temporary atraumatic vessel occlusion in infra-popliteal bypasses.
abstract: OBJECTIVE
  The study aims to assess a novel thermosensitive polymer (LeGoo(®)) for distal vessel control during infra-popliteal (crural/pedal) bypass surgery in severe leg ischaemia.
  
  
  METHODS
  Retrospective analysis of all distal bypasses from October 2009 to February 2012. Technical success, patency, limb salvage and amputation-free survival rates were analysed.
  
  
  RESULTS
  Fifty-four infra-popliteal bypasses using the polymer were performed in 46 patients. The distal anastomosis was at the anterior tibial (n = 15, 28%), posterior tibial (n = 12, 22%), peroneal (n = 8, 15%), tibio-peroneal trunk (n = 8, 15%) and dorsalis pedis arteries (n = 11, 20%). Technical success was achieved in 51/54 (94.4%; failures: two inadequate haemostasis, one un-dissolved polymer). In-hospital duplex of the distal anastomosis showed a significant stenosis in two cases (4.3%). Outflow angioplasty was performed in three cases (two distal anastomotic, one run-off vessel, 5.6%). The 1-year patency rate was 76.2% (standard error (SE) 6.7%), limb salvage rate 79.3% (SE 6.7%). Amputation-free survival was 93.5% at 30 days (SE 3.6%) and 67.5% at 1 year (SE 7.5%).
  
  
  CONCLUSIONS
  This thermosensitive polymer is a potentially safe and useful atraumatic device to achieve a blood-less distal anastomotic field in infra-popliteal bypasses. The technique avoids other potentially traumatic methods of vessel control, which may be particularly important in patients with calcified distal vessels.
authors.affiliation: Department of Vascular Surgery, King's Health Partners, King's College London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Mani
authors.forename: A
authors.initials: A
authors.lastname: Campbell
authors.forename: J
authors.initials: J
authors.lastname: Fitzpatrick
authors.forename: B
authors.initials: B
authors.lastname: Modarai
authors.forename: T
authors.initials: T
authors.lastname: Carrell
authors.forename: H
authors.initials: H
authors.lastname: Rashid
authors.forename: H
authors.initials: H
authors.lastname: Zayed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D017130:Angioplasty; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001831:Body Temperature; D003250:Constriction; D004617:Embolism / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D020442:Poloxamer / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D011150:Popliteal Artery / Q000503:physiopathology / Q000601:surgery*; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects / Q000401:mortality; D014654:Vascular Patency
chemical_list: C539704:LeGoo; D020442:Poloxamer