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Anteromedial Approach to the Popliteal Artery for Femoropopliteal Arterial Grafting

Anteromedial Approach to the Popliteal Artery for Femoropopliteal Arterial Grafting Abstract In our experience, many instances of late failure after grafting operations for femoropopliteal occlusive disease have been due to incomplete correction of the obliterative process at the popliteal level.1 On scrutinizing the operative details of these cases, we have observed, moreover, that the incompleteness of the surgical procedure was the result of one of two circumstances: Often the disease was too far advanced to have been completely circumvented by any means; in such situations no operative technical factor could be implicated. In a significant number of cases, however, the corrective operations had to be stopped short of the optimal distal level, owing to the impossibility of exposing the distal reaches of the involved arterial tree through the conventional femoral incision. The obvious technical maneuver to overcome this problem Was the division of the angioplastic procedure into two steps: obtaining access to the upper femoral artery through a standard thigh References 1. It should be pointed out—perhaps superfluously—that the working space obtained by means of the anteromedial tibial approach is not sufficient for the performance of surgical procedures on the popliteal artery more extensive than the arterial anastomosis being discussed. If one wishes to carry out operations of greater magnitude (aneurysmectomy, endarteriectomy, etc.) one must use a posterior approach, or, for a medial approach, one must sacrifice tendinous and muscular continuity in order to gain added space. 2. Szilagyi, D. E.; Whitcomb, J. G., and Smith, R. F.: The Causes of Late Failures in Grafting Therapy of Peripheral Occlusive Arterial Disease , Ann. Surg. 144:611 ( (Oct.) ) 1956.Crossref 3. Szilagyi, D. E.; Whitcomb, J. G.; Smith, R. F., and France, L. C.: Arterial Substitutes: A Study of Homografts and Elastic Plastic Prostheses, Scientific Exhibit, 43d Annual Clinical Congress of the American College of Surgeons, Oct. 14-18, 1957, Atlantic City. 4. Szilagyi, D. E.; France, L. C.; Smith, R. F., and Whitcomb, J. G.: The Clinical Use of an Elastic Dacron Prosthesis , A. M. A. Arch. Surg. 77:538 ( (Oct.) ) 1958.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

Anteromedial Approach to the Popliteal Artery for Femoropopliteal Arterial Grafting

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Publisher
American Medical Association
Copyright
Copyright © 1959 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1959.04320040141028
Publisher site
See Article on Publisher Site

Abstract

Abstract In our experience, many instances of late failure after grafting operations for femoropopliteal occlusive disease have been due to incomplete correction of the obliterative process at the popliteal level.1 On scrutinizing the operative details of these cases, we have observed, moreover, that the incompleteness of the surgical procedure was the result of one of two circumstances: Often the disease was too far advanced to have been completely circumvented by any means; in such situations no operative technical factor could be implicated. In a significant number of cases, however, the corrective operations had to be stopped short of the optimal distal level, owing to the impossibility of exposing the distal reaches of the involved arterial tree through the conventional femoral incision. The obvious technical maneuver to overcome this problem Was the division of the angioplastic procedure into two steps: obtaining access to the upper femoral artery through a standard thigh References 1. It should be pointed out—perhaps superfluously—that the working space obtained by means of the anteromedial tibial approach is not sufficient for the performance of surgical procedures on the popliteal artery more extensive than the arterial anastomosis being discussed. If one wishes to carry out operations of greater magnitude (aneurysmectomy, endarteriectomy, etc.) one must use a posterior approach, or, for a medial approach, one must sacrifice tendinous and muscular continuity in order to gain added space. 2. Szilagyi, D. E.; Whitcomb, J. G., and Smith, R. F.: The Causes of Late Failures in Grafting Therapy of Peripheral Occlusive Arterial Disease , Ann. Surg. 144:611 ( (Oct.) ) 1956.Crossref 3. Szilagyi, D. E.; Whitcomb, J. G.; Smith, R. F., and France, L. C.: Arterial Substitutes: A Study of Homografts and Elastic Plastic Prostheses, Scientific Exhibit, 43d Annual Clinical Congress of the American College of Surgeons, Oct. 14-18, 1957, Atlantic City. 4. Szilagyi, D. E.; France, L. C.; Smith, R. F., and Whitcomb, J. G.: The Clinical Use of an Elastic Dacron Prosthesis , A. M. A. Arch. Surg. 77:538 ( (Oct.) ) 1958.Crossref

Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: Apr 1, 1959

References