title: Using the diamond intermediate anastomosis in composite sequential bypass grafting for critical limb ischemia.
abstract: Composite sequential bypass grafting is an effective alternative in the treatment of peripheral vascular disease when autologous vein is limited. We describe a modified technique for composite sequential bypass grafting anastomosis using a combination of synthetic graft with native vein connected via a common intermediate anastomotic junction, which also benefits from having additional outflow at the native, noncontiguous arteriotomy in a diamond configuration. This technique was piloted on six patients to treat critical limb ischemia when no other revascularization options were deemed suitable. Limb salvage with resolution of symptoms was achieved in all six patients at the 6-month follow-up. The diamond anastomosis is a promising method to maximize limb salvage using a unique composite sequential bypass configuration when native vein is limited.
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: Ailín C
authors.initials: AC
authors.lastname: Rogers
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Reddy
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland.
authors.forename: K Simon
authors.initials: KS
authors.lastname: Cross
authors.affiliation: Department of Surgery, University Hospital Waterford, Waterford, Ireland. Electronic address: drmorganmc@yahoo.co.uk.
authors.forename: Morgan P
authors.initials: MP
authors.lastname: McMonagle
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D016638:Critical Illness; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D020127:Recovery of Function; D012039:Regional Blood Flow; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene