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Isolated Popliteal Segment v Tibial Bypass: Comparison of Hemodynamic and Clinical Results

Isolated Popliteal Segment v Tibial Bypass: Comparison of Hemodynamic and Clinical Results Abstract • Clinical and hemodynamic results of isolated popliteal segment, tibial, and sequential bypass grafts were compared in a retrospective review. Results were good with vein grafts to either an isolated segment or infrapopliteal vessel, with five-year patency rates of 71% and 72%, respectively. Prosthetic grafts performed poorly in both groups, and sequential grafts appeared advantageous in such circumstances. Average ankle pressure increased 49 mm Hg following successful isolated segment grafts. Although less than with patent tibial or sequential grafts, improvement was sufficient to relieve rest pain in all instances and heal ischemic lesions or local amputations in all but four patients. If an adequate vein is available and a good tibial vessel exists, distal grafting may be elected, particularly if advanced ischemic lesions demand restoration of pulsatile flow to the foot. If such conditions are not present, isolated segment grafting will give highly satisfactory results. (Arch Surg 1984;119:775-779) References 1. Mannick JA, Jackson BT, Coffman JD, et al: Success of bypass vein grafts in patients with isolated popliteal artery segments . Surgery 1967; 61:17-25. 2. Purdy RT, Bole P, Makanju W, et al: Salvage of the ischemic lower extremity in patients with poor runoff . Arch Surg 1974;109:784-786.Crossref 3. Davis RC, Davies WT, Mannick JA: Bypass vein grafts in patients with distal popliteal artery occlusion . Am J Surg 1975;129:421-425.Crossref 4. Darling RC, in discussion, Davis RC, Davies WT, Mannick JA: Bypass vein grafts in patients with distal popliteal artery occlusion . Am J Surg 1975;129:421-425.Crossref 5. Veith FJ, Gupta SK, Daly V: Femoropopliteal bypass to the isolated popliteal segment: Is polytetrafluoroethylene graft acceptable? Surgery 1981;89:296-303. 6. Corson JD, Brewster DC, LaSalle AJ, et al: Comparative analysis of vein and prosthetic bypass grafts to the isolated popliteal artery . Surgery 1982;91:448-451. 7. Kaufman JL, Whittemore AD, Couch NP, et al: The fate of bypass grafts to an isolated popliteal artery segment . Surgery 1982;92:1027-1031. 8. Mason R, Lanfranchi A, Giron F: Isolated popliteal versus distal bypasses for limb salvage . Surg Gynecol Obstet 1982;155:49-53. 9. Bernhard VM, Ashmore CS, Evans WE, et al: Bypass grafting to distal arteries for limb salvage . Surg Gynecol Obstet 1972;135:219-224. 10. Imparato AM, Kim GE, Madayag M, et al: The results of tibial artery reconstruction procedures . Surg Gynecol Obstet 1974;138:33-38. 11. Dardik H, Ibrahim IM, Sprayregen S, et al: Revascularization of the peroneal artery . Surg Gynecol Obstet 1976;143:946-948. 12. Edwards WH, Wright RS: Tibial and peroneal bypass in severe occlusive disease of the lower extremities . Ann Surg 1976;183:710-718.Crossref 13. Reichle FA, Martinson MW, Rankin KP: Infrapopliteal arterial reconstruction in the severely ischemic lower extremity: A comparison of long-term results of peroneal and tibial bypasses . Ann Surg 1980;191:59-65.Crossref 14. Kacoyanis GP, Whittemore AD, Couch NP, et al: Femorotibial and femoroperoneal bypass vein grafts: A 15-year experience . Arch Surg 1981;116:1529-1534.Crossref 15. Edwards WS, Gerety E, Larkin J, et al: Multiple sequential femoral tibial grafting for severe ischemia . Surgery 1976;80:722-728. 16. Flinn WR, Flanigan DP, Verta MJ Jr, et al: Sequential femoral-tibial bypass for severe limb ischemia . Surgery 1980;88:357-365. 17. Jarrett F, Berkoff HA, Crummy AB, et al: Femorotibial bypass grafts with sequential technique: Clinical results . Arch Surg 1981;116:709-714.Crossref 18. Burdick JF, O'Mara C, Ricotta J, et al: The multiple sequential distal bypass graft: Improving nature's alternatives . Surgery 1981;89:536-542. 19. DeLaurentis DA, Friedmann P: Arterial reconstruction about and below the knee: Another look . Am J Surg 1971;121:392-396.Crossref 20. Friedmann P, DeLaurentis DA, Rhee SW: The sequential femoropopliteal bypass graft: A five-year experience . Am J Surg 1976;131:452-456.Crossref 21. Rosenfeld JC, Savarese RP, Friedmann P, et al: Sequential femoropopliteal and femorotibial bypasses: A ten-year follow-up study . Arch Surg 1981;116:1538-1543.Crossref 22. Brewster DC: Bypass to isolated popliteal artery segment , in Bergan JJ, Yao JST (eds): Evaluation and Treatment of Upper and Lower Extremity Circulatory Disorders . New York, Grune & Stratton Inc, 1984, pp 337-349. 23. Gupta SK, Veith FJ: Fate of patients with a blind popliteal artery segment: Limb loss with a patent femoropopliteal graft , in Veith FJ (ed): Critical Problems in Vascular Surgery . New York, Appleton-Century-Crofts, 1982, pp 241-250. 24. Brewster DC, LaSalle AJ, Robison JG, et al: Factors affecting patency of femoropopliteal bypass grafts . Surg Gynecol Obstet 1983;157: 437-442. 25. Mundth ED, Darling RC, Moran JM, et al: Quantitative correlation of distal arterial outflow and patency of femoropopliteal reversed saphenous vein grafts with intraoperative flow and pressure measurements . Surgery 1969;65:197-206. 26. Barner HB, Kaminski DL, Codd JE, et al: Hemodynamics of autogenous femoropopliteal bypass . Arch Surg 1974;109:291-293.Crossref 27. Knox WG, Finby N, Moscarella AA: Limitations of arteriography in determining operability for femoropopliteal occlusive disease . Ann Surg 1965;161:509-515.Crossref 28. Reichle FA, Tyson RR: Femoroperoneal bypass: Evaluation of potential for revascularization of the severely ischemic lower extremity . Ann Surg 1975;181:182-185.Crossref 29. Bergan JJ, Veith FJ, Bernhard VM, et al: Randomization of autogenous vein and polytetrafluoroethylene grafts in femoral-distal reconstruction . Surgery 1982;92:921-930. 30. Yeager RA, Hobson RW II, Jamil Z, et al: Differential patency and limb salvage for polytetrafluoroethylene and autogenous saphenous vein in severe lower extremity ischemia . Surgery 1982;91:99-103. 31. Edwards WH, Mulherin JL Jr: The role of graft material in femorotibial bypass grafts . Ann Surg 1980;191:721-726.Crossref 32. Sumner DS, Strandness DE: Hemodynamic studies before and after extended bypass grafts to the tibial and peroneal arteries . Surgery 1979; 86:442-452. 33. Jarrett F, Perea A, Begelman K, et al: Hemodynamics of sequential bypass grafts in peripheral arterial occlusions . Surg Gynecol Obstet 1980; 150:377-378. 34. Grondin CM, Limet R: Sequential anastomoses in coronary artery bypass grafting: Technical aspects and early and late angiographic results . Ann Thorac Surg 1977;23:1-8.Crossref 35. McNamara JJ, Bjerke HS, Chung GKT, et al: Blood flow in sequential vein grafts . Circulation 1979;60( (suppl 1) ):33-38.Crossref 36. Hadcock MM, Ubatuba J, Littooy FN, et al: Hemodynamics of sequential grafts . Am J Surg 1983;146:170-173.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Isolated Popliteal Segment v Tibial Bypass: Comparison of Hemodynamic and Clinical Results

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1984.01390190019004
Publisher site
See Article on Publisher Site

Abstract

Abstract • Clinical and hemodynamic results of isolated popliteal segment, tibial, and sequential bypass grafts were compared in a retrospective review. Results were good with vein grafts to either an isolated segment or infrapopliteal vessel, with five-year patency rates of 71% and 72%, respectively. Prosthetic grafts performed poorly in both groups, and sequential grafts appeared advantageous in such circumstances. Average ankle pressure increased 49 mm Hg following successful isolated segment grafts. Although less than with patent tibial or sequential grafts, improvement was sufficient to relieve rest pain in all instances and heal ischemic lesions or local amputations in all but four patients. If an adequate vein is available and a good tibial vessel exists, distal grafting may be elected, particularly if advanced ischemic lesions demand restoration of pulsatile flow to the foot. If such conditions are not present, isolated segment grafting will give highly satisfactory results. (Arch Surg 1984;119:775-779) References 1. Mannick JA, Jackson BT, Coffman JD, et al: Success of bypass vein grafts in patients with isolated popliteal artery segments . Surgery 1967; 61:17-25. 2. Purdy RT, Bole P, Makanju W, et al: Salvage of the ischemic lower extremity in patients with poor runoff . Arch Surg 1974;109:784-786.Crossref 3. Davis RC, Davies WT, Mannick JA: Bypass vein grafts in patients with distal popliteal artery occlusion . Am J Surg 1975;129:421-425.Crossref 4. Darling RC, in discussion, Davis RC, Davies WT, Mannick JA: Bypass vein grafts in patients with distal popliteal artery occlusion . Am J Surg 1975;129:421-425.Crossref 5. Veith FJ, Gupta SK, Daly V: Femoropopliteal bypass to the isolated popliteal segment: Is polytetrafluoroethylene graft acceptable? Surgery 1981;89:296-303. 6. Corson JD, Brewster DC, LaSalle AJ, et al: Comparative analysis of vein and prosthetic bypass grafts to the isolated popliteal artery . Surgery 1982;91:448-451. 7. Kaufman JL, Whittemore AD, Couch NP, et al: The fate of bypass grafts to an isolated popliteal artery segment . Surgery 1982;92:1027-1031. 8. Mason R, Lanfranchi A, Giron F: Isolated popliteal versus distal bypasses for limb salvage . Surg Gynecol Obstet 1982;155:49-53. 9. Bernhard VM, Ashmore CS, Evans WE, et al: Bypass grafting to distal arteries for limb salvage . Surg Gynecol Obstet 1972;135:219-224. 10. Imparato AM, Kim GE, Madayag M, et al: The results of tibial artery reconstruction procedures . Surg Gynecol Obstet 1974;138:33-38. 11. Dardik H, Ibrahim IM, Sprayregen S, et al: Revascularization of the peroneal artery . Surg Gynecol Obstet 1976;143:946-948. 12. Edwards WH, Wright RS: Tibial and peroneal bypass in severe occlusive disease of the lower extremities . Ann Surg 1976;183:710-718.Crossref 13. Reichle FA, Martinson MW, Rankin KP: Infrapopliteal arterial reconstruction in the severely ischemic lower extremity: A comparison of long-term results of peroneal and tibial bypasses . Ann Surg 1980;191:59-65.Crossref 14. Kacoyanis GP, Whittemore AD, Couch NP, et al: Femorotibial and femoroperoneal bypass vein grafts: A 15-year experience . Arch Surg 1981;116:1529-1534.Crossref 15. Edwards WS, Gerety E, Larkin J, et al: Multiple sequential femoral tibial grafting for severe ischemia . Surgery 1976;80:722-728. 16. Flinn WR, Flanigan DP, Verta MJ Jr, et al: Sequential femoral-tibial bypass for severe limb ischemia . Surgery 1980;88:357-365. 17. Jarrett F, Berkoff HA, Crummy AB, et al: Femorotibial bypass grafts with sequential technique: Clinical results . Arch Surg 1981;116:709-714.Crossref 18. Burdick JF, O'Mara C, Ricotta J, et al: The multiple sequential distal bypass graft: Improving nature's alternatives . Surgery 1981;89:536-542. 19. DeLaurentis DA, Friedmann P: Arterial reconstruction about and below the knee: Another look . Am J Surg 1971;121:392-396.Crossref 20. Friedmann P, DeLaurentis DA, Rhee SW: The sequential femoropopliteal bypass graft: A five-year experience . Am J Surg 1976;131:452-456.Crossref 21. Rosenfeld JC, Savarese RP, Friedmann P, et al: Sequential femoropopliteal and femorotibial bypasses: A ten-year follow-up study . Arch Surg 1981;116:1538-1543.Crossref 22. Brewster DC: Bypass to isolated popliteal artery segment , in Bergan JJ, Yao JST (eds): Evaluation and Treatment of Upper and Lower Extremity Circulatory Disorders . New York, Grune & Stratton Inc, 1984, pp 337-349. 23. Gupta SK, Veith FJ: Fate of patients with a blind popliteal artery segment: Limb loss with a patent femoropopliteal graft , in Veith FJ (ed): Critical Problems in Vascular Surgery . New York, Appleton-Century-Crofts, 1982, pp 241-250. 24. Brewster DC, LaSalle AJ, Robison JG, et al: Factors affecting patency of femoropopliteal bypass grafts . Surg Gynecol Obstet 1983;157: 437-442. 25. Mundth ED, Darling RC, Moran JM, et al: Quantitative correlation of distal arterial outflow and patency of femoropopliteal reversed saphenous vein grafts with intraoperative flow and pressure measurements . Surgery 1969;65:197-206. 26. Barner HB, Kaminski DL, Codd JE, et al: Hemodynamics of autogenous femoropopliteal bypass . Arch Surg 1974;109:291-293.Crossref 27. Knox WG, Finby N, Moscarella AA: Limitations of arteriography in determining operability for femoropopliteal occlusive disease . Ann Surg 1965;161:509-515.Crossref 28. Reichle FA, Tyson RR: Femoroperoneal bypass: Evaluation of potential for revascularization of the severely ischemic lower extremity . Ann Surg 1975;181:182-185.Crossref 29. Bergan JJ, Veith FJ, Bernhard VM, et al: Randomization of autogenous vein and polytetrafluoroethylene grafts in femoral-distal reconstruction . Surgery 1982;92:921-930. 30. Yeager RA, Hobson RW II, Jamil Z, et al: Differential patency and limb salvage for polytetrafluoroethylene and autogenous saphenous vein in severe lower extremity ischemia . Surgery 1982;91:99-103. 31. Edwards WH, Mulherin JL Jr: The role of graft material in femorotibial bypass grafts . Ann Surg 1980;191:721-726.Crossref 32. Sumner DS, Strandness DE: Hemodynamic studies before and after extended bypass grafts to the tibial and peroneal arteries . Surgery 1979; 86:442-452. 33. Jarrett F, Perea A, Begelman K, et al: Hemodynamics of sequential bypass grafts in peripheral arterial occlusions . Surg Gynecol Obstet 1980; 150:377-378. 34. Grondin CM, Limet R: Sequential anastomoses in coronary artery bypass grafting: Technical aspects and early and late angiographic results . Ann Thorac Surg 1977;23:1-8.Crossref 35. McNamara JJ, Bjerke HS, Chung GKT, et al: Blood flow in sequential vein grafts . Circulation 1979;60( (suppl 1) ):33-38.Crossref 36. Hadcock MM, Ubatuba J, Littooy FN, et al: Hemodynamics of sequential grafts . Am J Surg 1983;146:170-173.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1984

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