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- Title
Tibial Artery Revascularization Utilizing Microscopic Vascular Technique.
- Authors
Tomikawa, Masaki; Ueyama, Takeshi; Yokokawa, Masayasu; Hashimoto, Hideki; Yamamoto, Keiichi
- Abstract
During the past six years and nine months, tibial artery revascularization was performed for 42 cases (47 limbs) utilizing the transmicroscopic vascular technique. The operations for limb salvage of the clinical stages III and IV accounted for 89.4% of all operations. Fifty-two operations were performed in all, including 3 secondary and 1 tertiary operative procedures. Each distal anastomosis on a tibial artery was completed with a continuous polypropylene 7-0 suture with the aid of an operative microscope, magnifying by 5 to 10 times. The greater saphenous vein was used as bypass and patch materials in all cases. Of 37 bypasses, classical reversed graft was adopted for 33 bypasses, including 7 sequential bypasses, while 4 bypasses were the in situ graft. Combined revascularization was performed simultaneously for 6 limbs and secondarily for 7 limbs for the purpose of improving the inflow. Forty-two cases were successfully followed up for one to eighty-one months postoperatively (24.1 months in average). There was neither operative death nor hospital death, but late death due to malignant tumor and thrombotic disease occurred in 5 cases. Early bypass occlusion was observed in 1 limb and late occlusion in 9 limbs. In 4 limbs with late occlusion, blood flow was restored satisfactorily by additional operation. Amputation was performed on 1 limb with late occlusion. The primary cumulative patency rate by Kaplan-Meier curve was 95.6% for six months, 85.0% for one year, and 65.0% for five years. The secondary rate was 95.6%, 87.7%, and 84.2% respectively. The transmicroscopic surgical technique can positively reduce anastomotic troubles during revascularization of infrapopliteal vessels, and it appears that this technique is a useful means of maintaining the long-term patency of the bypass to infrapopliteal vessels and, together with sequential bypass or the combined operation, to the inflow.
- Subjects
VASCULAR grafts; POLYPROPYLENE; ARTERIOVENOUS anastomosis; SAPHENOUS vein; CORONARY artery bypass
- Publication
Vascular Surgery, 1990, Vol 24, Issue 7, p475
- ISSN
0042-2835
- Publication type
Article
- DOI
10.1177/153857449002400704