Tourniquet Occlusion Technique for Infrapopliteal Artery Revascularization

ABSTRACT

Refinements in surgical technique have resulted in significant improvement in the patency rates of infrapopliteal artery revascularizations, but the cumulative patency rate were still low. Possibly the principle cause for the late graft failure was the constricting scar formation around the distal anastomosis following surgical injury. Thus we adopted a nondissection method, using pneumatic tourniquet occlusion technique, to simplify the procedure of distal anastomosis and to lessen the surgical injury. Six patients underwent infrapopliteal artery revascularizations with this method. Three of them were diagnosed with arteriosclerosis obliterans and the others with thromboangiitis obliterans. Tourniquet pressures of 350 mmHg were applied from 32 to 60 minutes. All patients were given systemic anticoagulants. The distal anastomoses were performed to peroneal artery in three cases, posterior tibial artery in two, and anterior tibial artery in one. Hemostasis was adequate in all cases and no alternative occlusive devices were required. There were no complications attributable to the use of the pneumatic tourniquet. Therefore we suggest that tourniquet occlusion technique may simplify the infrapopliteal artery revascularization and minimize surgical injury at the distal anastomosis contributed to the long-term patency of the distal bypass.