Sequential Femoral-tibial Bypass Grafting for Limb Salvage

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Abstract
Bypass grafting to distal lower extremity vessels continues to be associated with a high rate of graft occlusion. By utilizing a sequential side-to-side anastomosis between saphenous vein and popliteal aretery in femoral-tibial bypass grafts, runoff can be increased and graft patency improved. Sequential femoral-tibial grafts were employed in 7 patients with gangrene, trophic changes or restpain, all of whom had single-vessel runoff by arteriography. All 7 sequential grafts established to a distal vessel in addition to the popliteal artery remained open for periods of 5-27 mo. as determined by palpable graft or foot pulses. Two patients underwent below-knee amputation within 6 mo. of operation but had patent grafts at the time of amputation. In 3 patients ischemic ulcers resolved and in 2 patients toe amputations healed successfully. Sequential bypass grafting is a technique aimed at improving the patency rate of femoral-tibial bypass grafts by augmenting runoff.