Advertisement

Follow-Up Studies and Conclusions

  • M. Dusmet

Abstract

Most procedures for lower-limb ischemia involve the iliosuperficial femoral axis. However, in a small but significant number of patients who have often undergone one or more reconstructive procedures, an alternative approach is required. The deep femoral artery (DFA) can be an ideal relatively disease-free site for anastomosis in the management of these difficult patients. In proximal procedures the DFA can provide sufficient runoff to maintain patency providing it has a well-developed collateral network and a patent popliteal artery (PA) with at least one good crural artery. Under these conditions ischemic lesions will heal and claudication can be completely relieved. In distal bypasses a healthy DFA can offer an alternative source of inflow. This is particularly useful in two circumstances: when the groin is heavily scarred by previous operations or is infected, and when a more distal site is required for a venous femorodistal bypass and only a short amount of vein is available. Finally, as described in detail by van Dongen (Chap. 9), profundaplasty can be a precious limb-saving operation in carefully selected patients.

Keywords

Vein Graft Popliteal Artery Duplex Scanning Deep Femoral Artery Graft Stenosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bacharach JM, Rooke TW, Osmundson PJ, Gloviczki P (1992) Predictive value of transcutaneous oxygen pressure and amputation success by use of supine and elevation measurements. J Vase Surg 15: 558–563CrossRefGoogle Scholar
  2. Bandyk DF (1990) Postoperative surveillance of infrainguinal bypass. Surg Clin North Am 70: 71–85PubMedGoogle Scholar
  3. Bandyk DF, Schmitt DD, Seabrook GR, Adams MB, Towne JB (1989) Monitoring functional patency of in situ saphenous vein bypasses: the impact of a surveillance protocol and elective revision. J Vase Surg 9: 286–296Google Scholar
  4. Bandyk DF, Bergamini TM, Towne JB, Schmitt DD, Seabrook GR (1991) Durability of vein graft revision: the outcome of secondary procedures. J Vase Surg 13: 200–210CrossRefGoogle Scholar
  5. Baxter BT, Rizzo RJ, Flinn WR, Almgren CN, McCarthy WJ, Pearce WH, Yao JST (1990) A comparative study of intra-operative angioscopy and completion arteriography following femorodistal bypass. Arch Surg 125: 997–1002PubMedGoogle Scholar
  6. Berkowitz HD, Fox AD, Deaton DH (1992) Reversed vein graft stenosis: early diagnosis and management. J Vase Surg 15: 130–142CrossRefGoogle Scholar
  7. Brennan JA, Walsh AKM, Beard JD, Bolia AA, Bell PRF (1991) The role of simple non-invasive testing in infra-inguinal vein graft surveillance. Eur J Vase Surg 5: 13–17CrossRefGoogle Scholar
  8. Buth J, Disselhoff B, Sommeling C, Stam L (1991) Color-flow duplex criteria for grading stenosis in infrainguinal vein grafts. J Vase Surg 14: 716–728CrossRefGoogle Scholar
  9. Chang BB, Leather RP, Kaufman JL, Kupinski AM, Leopold PW, Shah DM (1990) Hemodynamic characteristics of failing infrainguinal in situ vein bypass. J Vase Surg 12: 596–600Google Scholar
  10. Green RM, McNamara J, Ouriel K, DeWeese JA (1990) Comparison of in-frainguinal graft surveillance techniques. J Vase Surg 11: 207–215Google Scholar
  11. Grigg MJ, Nicolaides AN, Wolfe JHN (1988) Femorodistal vein bypass graft stenosis. Br J Surg 75: 737–740PubMedCrossRefGoogle Scholar
  12. Harris PL (1992) Vein graft surveillance - all part of the service. Br J Surg 79: 97–98PubMedCrossRefGoogle Scholar
  13. Idu MM, Truyen E, Buth J (1992) Surveillance of lower extremity vein grafts. Eur J Vase Surg 6: 456–462CrossRefGoogle Scholar
  14. Idu MM, Blankenstein JD, de Gier P, Truyen E, Buth J (1993) Impact of a color- flow duplex surveillance program on infrainguinal vein graft patency: a five-year experience. J Vase Surg 17: 42–53CrossRefGoogle Scholar
  15. Karacagil S, Almgren B, Bowald S, Eriksson I (1990) A new method of angio-graphic runoff evaluation in femorodistal reconstructions. Significant correlation with early graft patency. Arch Surg 125: 1055–1058PubMedGoogle Scholar
  16. Killewich LA, Fischer C, Bartlett ST (1990) Surveillance of in situ infrainguinal bypass grafts: conventional vs. color flow duplex ultrasonography. J Cardiovasc Surg 31: 662–667Google Scholar
  17. Kretschmer G, Herbst F, Prager M, Sautner T, Wenzl E, Berlakovich GA, Zekert F, Marosi L, Schemper M (1992) A decade of oral anticoagulant treatment to maintain antologous vein grafts for femoropopliteal atherosclerosis. Arch Surg 127: 1112–1115PubMedGoogle Scholar
  18. Mattos MA, van Bemmelen PS, Hodgson KJ, Ramsey DE, Barkmeier LD, Sumner DS (1993) Does correction of stenoses identified with color duplex scanning improve infrainguinal graft patency? J Vase Surg 17: 54–66CrossRefGoogle Scholar
  19. Miller A, Marcaccio EJ, Tannenbaum GA, Kwolek CJ, Stonebridge PA, Lavin PT, Gibbons GW, Pomposelli FB, Freeman DV, Campbell DR, LoGerfo FW (1993) Comparison of angioscopy and angiography for monitoring infrainguinal bypass vein grafts: results of a prospective randomized trial. J Vase Surg 17: 382–398CrossRefGoogle Scholar
  20. Mills JL, Harris EJ, Taylor LM, Beckett WC, Porter JM (1990) The importance of routine surveillance of distal bypass grafts with duplex scanning: a study of 379 reversed vein grafts. J Vase Surg 12: 379–389Google Scholar
  21. Mills JL, Fujitani RM, Taylor SM (1993) The characteristics and anatomic distribution of lesions that cause reversed vein graft failure: a five-year prospective study. J Vase Surg 17: 195–206CrossRefGoogle Scholar
  22. Sanchez LA, Gupta SK, Veith FJ, Goldsmith J, Lyon RT, Wengerter KR, Panetta TF, Marin ML, Cynamon J, Berdejo G, Sprayregen S, Bakal CW (1991) A ten-year experience with one hundred fifty failing or threatened vein and polytetrafluoroethylene arterial bypass grafts. J Vase Surg 14: 729–738CrossRefGoogle Scholar
  23. Stierli P, Aeberhard P, Livers M (1992) The role of colour flow duplex screening in infra-inguinal vein grafts. Eur J Vase Surg 6: 293–298CrossRefGoogle Scholar
  24. Wyatt MG, Muir RM, Tennant WG, Scott DJA, Horrocks M (1990) An objective comparison of four stress tests in the assessment of “at risk” femoro-distal grafts. J Cardiovasc Surg 31: 340–343Google Scholar
  25. Wyatt MG, Muir RM, Tennant WG, Scott DJA, Baird RN, Horrocks M (1991) Impedance analysis to identify the at risk femorodistal graft. J Vase Surg 13: 284–293CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • M. Dusmet

There are no affiliations available

Personalised recommendations