Assessment of the outcome after popliteal distal bypass for limb salvage

Twenty four patients with limb threatening ischaemia due to occlusion of the popliteal artery were included in this prospective study. The patients were considered potential for surgery due to presence of ischaemic ulcer or gangrene in 15 patients and ischaemic rest pain alone in 9 patients. The inclusion criteria for popliteal distal bypass was short segment occlusive diseases of the popliteal artery and its trifurcation. Patients with diffuse disease of the superficial femoral artery were excluded from this study. Popliteal artery bypasses were performed electively in all patients. Autogenous vein as a conduit was utilized in all of them. Translocated saphenous vein was the most frequent conduit used in 12 patients [50%]. In situ saphenous vein was utilized in 9 patients [37.5%] where as reversed saphenous vein was used in 3 patients [12.5%]. The inflow vessels were below knee popliteal artery in 14 patients [58.3%] and above knee popliteal artery in 10 patients [41.7%]. The outflow were posterior tibial artery in 12 patients [50%], peroneal artery in 4 patients [16.6%] anterior tibial artery in 6 patients [25%] and dorsalis pedis artery in 2 patients [8.4%]. In the early and late postoperative periods, the survival rates were 95.83% and 87.50%, the primary patency rates were 91.30% and 80.95%, the secondary patency rates were 91.30% and 85.7% and limb salvage rates were 91.97% and 87.50% respectively which compare favorably with other reports of popliteal distal bypass. The same is true regarding reports for femorodistal bypass. At the end of the follow up period 16 [66.6%] out of 24 patients had a functioning limb used for ambulation and transfer. In conclusion, popliteal distal bypass is a safe and efficient procedure with favorable outcome. However, the results are poor in patients with renal impairment

Factors affecting the outcome of axillosubclavian arterial injuries

Twenty cases of subclavian artery injury and 14 cases of proximal artery injury were included in this study. Penetrating trauma was responsible for 26 cases of axillosubclavian arterial injuries, whereas blunt trauma accounted for only 8 patients. Thirty patients were presented with absent distal upper extremity pulses, while only four patients with subclavian artery injury suffered from a supraclavicular swelling with palpable distal pulses. Angiography was done in 17 patients who were vitally stable. Patients with soft signs that were suspicious of vascular injury underwent duplex study prior to angiography to confirm the diagnosis and angiography was followed to locate the site of the injury and to plan the operation. Four patients died before surgery and another four patients died intraoperatively from massive blood loss. Twenty patients needed saphenous interposition graft, four patients required venous patch, while the remaining two patients underwent a repair with synthetic graft [ringed PTFE, 8 mm] when suitably sized vein was not available and in the absence of contamination. The factors that influenced the mortality rate were the hemodynamic status of the patient, the presence of other associated injuries and the site of arterial injury. Preoperative ischemia time, the site of arterial injury and the presence of other associated injuries had a major impact as regards the postoperative morbidity. Associated brachial plexus injury is considered the most important item regarding postoperative morbidity, leaving the patient with very poor recovery of upper extremity function