Clinical Experiences of Pedal Bypass

ABSTRACT

PURPOSE: Bypasses to the infra-inguinal arteries using autologous vein are now routinely used for limb salvage and as this technique has evolved, the distal limits of revascularization have been extended to near the ankle or in the foot. As the prevelances of chronic renal failure, diabetes and Buerger's disease increased, the more infrapopliteal arterial occlusions were detected. But the safety and effect of pedal bypass was not reported so much in our society. So we studied our cases of ankle bypass to find out its effect on preventing from primary amputation in infrapopliteal arterial occlusive diseases. METHOD: From July 2000 to December 2000, 12 cases of ankle bypasses were performed and followed most of them up to May 2001. The underlying diseases included 6 cases of atherosclerosis obliterance and 6 cases of Buerger's disease. Surgical indications were 9 minor toe gangrene, 2 major gangrene and 1 intractable resting pain. The surgical procedures were 3 popliteo-distal bypasses, 3 popliteo-distal bypasses after femoral thrombectomy, 2 above knee popliteo-below knee popliteo-distal sequential bypasses, 2 combined bypasses of femoro-above knee popliteal bypass and below knee popliteo-distal bypass, and 2 femoro-above knee popliteo-below knee popliteo-distal sequential bypasses. The distal bypass sites were 8 posterior tibial artery (PTA) near medial malleolous, 2 dorsalis pedis (DP) and 2 PTA-DP sequentially. RESULT: There were 2 cases of early occlusion from graft thrombosis and 1 case of late occlusion from inflow embolism. These 3 cases were revised and rebypassed. There was one case of amputation due to deep metatarsal infection. One patient with atherosclerosis died of acute myocardial infarction a month after bypass operation. One patient who underwent bilateral bypass was lost to follow up. The others showed patent graft unil may 2001. 3 patients underwent toe amputation but they didn't have any problem in bipedal ambulation. CONCLUSION: Ankle bypass is safe and promising procedure in infrainguinal arterial occlusive disease.